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mw  WORKS  AND  NEW  EDITIONS 

PUBLISHED  BY  LEA  AND  BLANCHARD. 


LISTON  AND  MUTTER’S  SURGICAL  LECTURES. 

X^XSCTVRES  orr  the  0FERATI03^JS  of  SURaERir, 

AND  ON  DISEASES  AND  ACCIDENTS  REOCIRING  OPERATIONS, 

DELIVERED  AT  UNIVERSITY  COLLEGE,  LONDON, 

By  ROBERT  LISTON,  Esq.,  F.R.S.,  &c. 

EDITED,  WITH  NUMEROUS  ALTERATIONS  AND  ADDITIONS,  BY 

T.  D.  MUTTER,  M.D., 

PROFESSOR  OF  SURGERY  IN  THE  JEFFERSON  MEDICAL  COLLEGE,  PHILADELPHIA. 

With  JYumerous  Illustrations  on  Wood. 

In  One  Large  Octavo  Volume,  beautifully  Printed. 

This  work  contains  much  original  matter  of  Professor  MUtter’s,  embodying  the 
results  of  his  great  experience,  and  adapting  the  whole  to  the  wants  of  the  Ame- 
rican Profession.  The  Lectures  are  those  which  attracted  so  much  attention  when 
published  in  the  Lancet.  They  are  here  presented  entire,  omitting  none  of  the 
original  illustrations,  and  introducing  numerous  new  and  valuable  ones. 

In  Press, 

HUGHES  ON  THE  LUNGS  AND  HEART. 

CLINICAL  INTRODUCTION  TO  THE 

PRACTICE  OF  AFSC FETATION, 

AND  OTHER  MODES  OF  PHYSICAL  DIAGNOSIS. 

Intended  to  Simplify  the  Study  of  the  Diseases  of  the  Heart  and  Lungs, 

By  H.  M.  hughes,  M.D.,  &c. 

In  One  Duodecimo  Volume,  (nearly  ready.) 

CHURCHIEE’i~MIDWIFERY, 

WITH  NUMEROUS  ADDITIONS. 

JVew  Edition,  just  Published. 

L.  & B.  have  just  issued  a new  edition  of  this  valuable  and  standard  work  on 
the  Theory  and  Practice  of  Midwifery,  edited  by  Huston,  in  One  Octavo  Volume, 
well  bound,  with  numerous  illustrations. 


Also^  Lately  Published, 

NEW  EDITIONS  OF 

PEREIRA’S  MATERIA  MEDICA, 

REVISED,  WITH  ADDITIONS,  BY  CARSON, 

In  Two  Large  Octavo  Volumes,  many  Cuts, 

AND  OF 

WATSON’S  PRACTICE  OF  PHYSIC, 

EDITED  BY  CONDIE, 

in  One  Octavo  Volume,  of  nearly  Eleven  Hundred  Large  Pages, 
bound  in  strong  Leather,  with  raised  bands. 


LEA  & BLANCHARD’S  LATE  PUBLICATIONS. 


SIMON’S  CHEMKTRY  OF  MAN. 

ANIMAL  CHEMISTRY, 

WITH  REFERENCE  TO  THE  PHYSIOLOGY  AND  PATHO- 
LOGY OF  MAN. 

Bv  DR.  J.  FRANZ  SIMON, 

TRANSLATED  AND  EDITED  BY 
GEORGE  E.  DAY,  M.A.  & L.M.  Cantab.,  &c. 

TO  BE  COMPLETE  IN  TWO  PARTS. 

Part  I.  now  ready,  in  8vo.  boards,  uncut. 

With  a Plate. 

The  first  part  of  Dr.  Simon’s  valuable  work,  as  here  presented,  has  been  lately 
published  by  the  Sydenham  Society  of  London.  As  it  is  uncertain  when  the 
second  part  may  be  expected,  the  publishers  have  thought  it  best  to  issue  it  in 
the  present  form  exactly  as  it  appeared  in  London  and  uncut,  so  that  when  the 
second  is  published,  purchasers  may  have  them  bound  to  soil  their  convenience. 

“ A work  that  obtained  for  its  author  a European  reputation,  and  is  universally 
regarded  as  by  far  the  most  complete  treatise  that  has  yet  appeared  on  Physio- 
logical Chemistry.” — Editor's  Preface. 

“ No  treatise  on  physiological  chemistry  approaches,  in  fullness  and  accuracy 
ofdetail,  the  work  which  stands  at  the  head  of  this  article.  It  is  the  production  of 
a man  of  true  German  assiduity,  who  has  added  to  his  own  re.searches  the  results 
of  the  labours  of  nearly  every  other  inquirer  in  this  interesting  branch  of  science. 
The  death  of  such  a labourer,  which  is  mentioned  in  the  preface  to  the  work  as 
having  occurred  prematurely  in  1843,  is  indeed  a calamity  to  science.  He  had 
hardly  reached  the  middle  term  of  life,  and  yet  had  made  himself  known  all  over 
Europe,  and  in  our  country,  where  his  name  has  been  familiar  for  several  years, 
as  among  the  most  successful  of  the  cultivators  of  the  chemistry  of  man.  * * * 

It  is  a vast  repository  of  facts,  to  which  the  teacher  and  student  may  refer  with 
equal  satisfaction.” — The  Western  Journal  of  Medicine  and  Surgery. 

“ Several  reasons  combine  to  render  Dr.  Simon’s  work  peculiarly  valuable.  In 
the  first  place,  the  author  evidently  understands  his  subject,  and  discusses  it  with 
great  ability , in  the  next  place,  his  opinions  have  been  formed,  in  a great  measure, 
from  original  investigations;  and  lastly,  he  seems  to  have  no  theories  beyond 
facts  — no  dogmas  to  sustain  at  the  expense  of  truth  and  principle  ; but  he  enters 
upon  the  investigation  like  a true  philosopher,  and  the  result  is  such  as  we  have 
seen.  — The  Western  Lancet. 


BU1>D  ON  THE  EIYEM. 

ON  DISEASES  OF  THE  LIVER. 

By  GEORGK  BUDO,  M.D.,  F.R.S.,  &c. 

With  WoodcuU  and  Coloured  Plates  in  the  First  Style  of  Art. 

In  One  Octavo  Volume,  Sheep. 

“ We  cannot  too  strongly  recommend  the  diligent  study  of  this  volume.  The 
work  cannot  fail  to  rank  the  name  of  its  author  among  the  most  enlightened  pa- 
thologists and  soundest  practitioners  of  the  day.”  — Medico-Chirurgical  Review. 


LEA  AND  BLANCHARD’S  LATE  PUBLICATIONS- 


BIRD  ON  URINARY  DEPOSITS. 

URINARY~DEPOSITS. 

THEIR  DIAGNOSIS,  PATHOLOGY,  AND  THERAPEUTICAL 

INDICATIONS. 

By  GOLDING  BIRD,  A.M.,  M.D.,  &c. 

In  One  Octavo  Volume,  Cloth,  with  Cuts. 

“ One  of  the  best  fruits  of  this  ‘ revival  ’ in  urinary  pathology  is  the  work  of 
Dr.  Golding  Bird,  which  we  are  about  introducing  to  the  notice  of  our  readers. 

“In  1843,  Dr.  Bird  delivered  a course  of  lectures  on  the  diagnosis  and  pathology 
of  urinary  sediments.  They  were  published  in  the  London  Medical  Gazette,  at- 
tracted much  attention  at  the  time,  and  were  subsequently  translated  into  German. 
These  lectures  form  the  groundwork  of  the  present  publication,  though  much  ex- 
tended and  nearly  rewritten. 

“ From  the  space  which  we  have  given  to  the  consideration  of  this  little  vol- 
ume, our  readers  will  naturally  infer  the  exalted  opinion  we  entertain  of  it.  Yet 
we  fear  we  have  still  conveyed  a very  inadequate  notion  of  its  merits.  Where 
almost  every  thing  is  of  value,  it  is  difficult  to  select  or  condense.  Such  of  our 
readers  as  wish  to  increase  their  store  of  practical  knowledge,  and  enlarge  the 
sphere  of  their  usefulness,  we  refer  to  the  volume  itself,  and  recommend  its  pos- 
session. We  now  take  leave  of  Dr.  Bird,  with  an  expression  of  great  readiness 
to  meet  him  again  in  the  same,  or  some  analogous  line  of  investigation.” — Amer- 
ican Medical  Journal. 


DURLACHER  ON  CORNS,  BUNIONS,  ETC. 

A Treatise  on  Corns,  Bunions, 

THE  DISEASES  OF  THE  NAILS, 

AND  THE  GENERAL  MANAGEMENT  OF  THE  FEET. 

BY  LEWIS  DURLACHER, 

Surgeon  Chiropodist  by  Special  Appointment  to  the  ^ueen. 

In  One  small  Duodecimo  Volume,  Cloth. 

“ These  important  subjects  are  in  this  work  lifted  above  the  quackery  which 
has  generally  invested  them,  and  we  find  them  treated  with  evident  marks  of  sci- 
ence and  education.” — North  American. 

“ This  is  a work  by  an  educated  scientific  man  upon  a subject  which  has  been 
almost  given  up  to  quackery,  but  which  thousands  will  agree  to  be  of  the  highest 
importance.  The  advice  and  prescriptions  are  of  great  value  to  all  who  are  trou- 
bled with  the  diseases  of  the  feet.”  — Providence  Journal. 


liately  Piiblisliefl, 

A NEW  AND  MUCH  IMPROVED  EDITION  OF 

DRUITT’S  SURGERY. 

THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY. 

By  ROBERT  DRUITT,  Surgeon. 

FROM  THE  THIRD  LONDON  EDITION. 

ILLUSTRATED  BY  ONE  HUNDRED  AND  FIFTY-THREE  WOOD  ENGRAVINGS. 
WITH  NOTES  AND  COMMENTS, 

By  JOSHUA  B.  FLINT,  M.  M,  S.  S. 

In  One  volume  8vo. 

“ An  unsurpassable  compendium  not  only  of  surgical  but  of  medical  practice.” 

London  Medical  Gazette. 


LEA  & BLANCHARD’S  LATE  PUBLICATIONS. 


CHELIUS’S  SYSTEM  OF  SURGERY. 

A SYSTEM  OF  SURGERY, 

BY  J.  M.  CHELIUS, 

DOCTOR  IN  MEDICINE  AND  SURGERY,  PUBLIC  PROFESSOR  OF  GENERAL  AND  OPHTHALMIC 
SURGERY,  &C.,  &C.,  IN  THE  UNIVERSITY  OF  HEIDELBERG. 

TRANSLATED  FROM  THE  GERMAN, 

AND  ACCOMPANIED  WITH  ADDITIONAL  NOTES  AND  OBSERVATIONS, 

BY  JOHN  F.  SOUTH, 

SURGEON  TO  ST.  THOMAS’S  HOSPITAL. 

EDITED  WITH  FURTHER  ADDITIONS, 

BY  GEORGE  W.  NORRIS,  M.  D. 

Publishing  in  JYumberSy  at  Fifty  Cents  each. 

SIX  NUMBERS  ARE  NOW  READY. 

“Judging  from  a single  number  only  of  this  work,  we  have  no  hesitation  in 
saying  that,  if  the  remaining  portions  correspond  at  all  with  the  first,  it  will  be  by 
far  the  most  complete  and  scientific  system  of  surgery  in  the  English  language. 
We  have,  indeed,  seen  no  work  which  so  nearly  comes  up  to  our  idea  of  what 
such  a production  should  be  both  as  a practical  guide  and  as  a work  of  reference, 
as  this  ; and  the  fact  that  it  has  passed  through  six  editions  in  Germany,  and  been 
translated  into  seven  languages,  is  sufficiently  convincing  proof  of  its  value.  It 
is  riiethodical  and  concise,  clear  and  accurate:  omitting  all  minor  details  and 
fruitless  speculations,  it  gives  us  all  the  information  we  want  in  the  shortest 
and  simplest  form.” — The  New  York  Journal  of  Medicine. 

A NEW  AND  IMPROVED  EDITION  OF 

FERGUSSON’S  OPERATIVE  SURGERY. 

A System  of  Practical  Surgery, 

BY  WILLIAM  FERGUSSON,  P.  R.  S.  E. 

SECOND  AMERICAN  EDITION,  REVISED  & IMPROVED, 
ffith  tivo  hundred  and  fifty-txvo  Illustrations  from  draxvings  by  JBagg,  engraved 
by  Gilbert,  ivith  Notes  and  additional  Illustralions. 

BY  GEORGE  W.  NORRIS,  M.  D. 

In  one  beautiful  octavo  volume  of  six  hundred  and  forty  large  pages. 

The  publishers  commend  to  the  attention  of  the  profession  this  new  and  im- 
proved edition  of  Fergusson’s  standard  work,  as  combining  cheapness  and  elegances 
with  a clear,  sound,  and  practical  treatment  of  every  subject  in  surgical  science. 
Neither  pains  nor  expense  have  been  spared  to  make  it  worthy  of  the  reputation 
which  it  has  already  acquired,  and  of  which  the  rapid  exhaustion  of  the  first  edi- 
tion is  sufficient  evidence.  It  is  extensively  used  as  a text-book  in  many  medical 
colleges  throughout  the  country. 

BRODIE’S  SURG^AL  LUCTURES. 

L.  & B.  will  publish  about  March  1,  1846, 

CLINICAL  LECTURES  ON  SURGERY, 

BY  SIR  BENJAMIN  BRODIE,  BART.,  F.R.S  &c. 

In  one  neat  octavo  volume. 

These  Lectures,  in  passing  through  the  columns  of  “The  Medical  News”  du- 
ring the  last  year,  have  received  the  unanimous  approbation  of  the  profession  in 
this  country,  and  will  no  doubt  be  eagerly  sought  for  in  their  complete  slate. 


GENERAL 


THEEAPEUTICS 

AND 

MATEKIA  lEDICA. 

WITH  ONE  HUNDRED  AND  TWENTY  ILLUSTRATIONS. 

ADAPTED  FOR  A 

MEDICAL  TEXT  BODE. 


BY  ROBLEY  DUNGLISON,  M.D., 

PROFESSOR  OP  INSTITUTES  OF  MEDICINE,  ETC.,  IN  JEFFERSON  MEDICAL  COLLEGE  OF 

PHILADELPHIA, 

Formerly  Professor  of  Materia  Medica  and  Therapeutics  in  the  Universities  of  Virginia 
and  Maryland  and  in  Jefferson  Medical  College  of  Philadelphia. 


THIRD  EDITION,  REVISED  AND  IMPROVED. 
IN  TWO  VOLUMES. 

VOL.  I. 


PHILADELPHIA: 

LEA  AND  BLANCHARD. 
1 846. 


Entered,  according  to  the  Act  of  Congress,  in  the  year  one  thousand 
eight  hundred  and  forty-two,  by 
ROBLEY  DUNGLISON,  M.D., 
the  clerk’s  office  of  the  District  Court  for  the  Eastern  District  of  Pennsylvania. 


PREFACE 


TO  THE  THIRD  EDITION. 


In  preparing  the  present  edition,  the  Author  has  subjected  the 
General  Therapeutics  and  Materia  Medica  to  a thorough  revi- 
sion; and  has  endeavoured  so  to  modify  the  work  as  to  make 
it  a more  exact  and  complete  exponent  of  the  existing  state  of 
knowledge  on  these  important  subjects.  The  favour  with 
which  the  former  editions  were  received  demanded  of  him 
that  the  present  should  be  rendered  still  more  worthy  of  the 
patronage  of  the  profession,  and  particularly  of  the  student  of 
medicine  for  whose  use  it  was  more  especially  destined. 


109  South  Tenth  street, 
January,  1846. 


ROBLEY  DUNGLISON. 


TijF  THE 

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PREFACE 


TO  THE  LAST  EDITION. 


A SECOND  edition  of  the  work  on  General  Therapeutics  being 
called  for  by  his  publishers,  the  Author  has  deemed  it  advisable  to 
incorporate  with  it  an  account  of  the  different  articles  of  the  Materia 
Medica.  To  this  he  has  been  led  by  the  circumstance,  — that  the 
departments  of  General  Therapeutics  and  Materia  Medica  are  always 
associated  in  the  medical  schools. 

In  preparing  the  details  on  the  latter  department,  the  Author  has 
not  considered  it  advisable  to  go  farther  into  the  natural  and  commer- 
cial history  of  drugs  than  was  indispensable  for  the  medical  student. 
He  would  fain  hope,  that  the  time  may  arrive  when  an  acquaintance 
with  the  different  branches  of  Natural  History  may  be  esteemed  an 
essential  preliminary  or  accompanying  study;  but  as ‘the  medical 
schools  of  this  continent  are  now  constituted,  any  lengthened  inves- 
tigation of  these  subjects  by  the  Professor  would  be  manifestly  im- 
practicable. In  the  short  time  allotted  to  a session  of  medical  lec^ 
tures,  there  is  scarcely  opportunity  afforded  to  teach  that  which  is 
indispensable  to  the  therapeutist. 

In  all  cases,  the  Author  has  referred  to  the  position  held  by  the 
drug  as  an  article  of  the  organised,  or  of  the  inorganic  kingdom  ; as 
well  as  to  general  matters  of  interest  relative  to  the  place  where  it  is 
found,  the  manner  in  which  it  is  obtained,  and  to  certain  points 
connected  with  its  commercial  history;  but  next  to  therepeutical  ap- 
plications he  has  dwelt  more  at  length  on  the  sensible  properties,  by 
which  the  physician  may  be  enabled  to  judge  of  the  various  articles 
from  his  own  observation. 

In  another  work,  {The  Medical  Student,  p.  128,  Philadelphia, 
1837,)  the  Author  has.  remarked,  that  “it  would,  doubtless,  be  well, 
that  the  physician  should  know  the  natural  history  of  the  animal 
whence  he  obtains  his  castor,  his  musk,  &c.,  and  that  he  should  be 
acquainted  with  the  botanical  relations  of  the  plants,  whose  prepara- 
tions he  prescribes ; but  such  a knowledge  is  no  more  indi&p^nsable, 
than  Greek  is  to  an  acquaintance  with  medical  technology.  The  ar- 
gument may,  indeed,  be  extended  to  the  consumer  of  the  products  of 
1* 


VI 


PREFACE. 


the  animal  and  vegetable  kingdom  as  articles  of  diet.  It  would  be 
well  for  him,  no  doubt,  to  be  acquainted  with  the  natural  history  of  the 
ox,  the  sheep,  the  hog,  &c.,  whence  he  derives  his  sustenance ; yet, 
notwithstanding  his  ignorance  on  this  point,  universal  experience  de- 
monstrates, that  he  has  no  difficulty  in  appropriating  them  to  his 
dietetic  necessities.” 

Moreover,  there  are  already  valuable  works  in  which  all  these 
topics,  so  interesting  to  the  apothecary  especially,  are  given  at  such 
length  as  almost  to  exhaust  the  subject;  and  of  these  one  of  the  most 
remarkable  is  that  of  Dr.  Pereira,  which  is  now  in  the  press  under  the 
competent  supervision  of  Dr.  Carson,  Professor  of  Materia  Medica  in 
the  Philadelphia  College  of  Pharmacy.  Of  this,  the  Author  has 
availecThimself  in  the  preparation  of  the  present  work.  He  is  likewise 
greatly  indebted  to  the  full  and  accurate  Dispensatory  of  his  friends 
Drs.  Wood  and  Bache — his  learned  colleagues  in  the  last  revision  of 
the  Pharmacopoeia  of  the  United  States  (1842)  ; to  the  Dispensatory  of 
Dr.  Christison  (1842);  and  — in  a minor  degree  — to  the  recent  work 
on  Therapeutics  and  Materia  Medica,  by  MM.  Trousseau  and  Pidoux. 
Nor  have  the  modern  German  publications  on  the  subject  escaped  his 
attention. 

The  Author’s  great  object  has  been  to  prepare  a work  on  General 
Therapeutics  and  Materia  Medica,  which  may  aid  the  medical  stu- 
dent in  acquiring  the  main  results  of  modern  observation  and  reflec- 
tion ; and,  at  the  same  time,  be  to  the  medical  practitioner  a trust- 
worthy book  of  reference. 

The  views  of  General  Therapeutics  are  essentially  the  same  as  in 
the  first  edition.  The  author  has  subjected  them,  however,  to  a care- 
ful revision ; and  has  been  pleased  to  find,  that  the  period,  which  has 
elapsed  since  their  first  promulgation,  has  but  strengthened  his  belief 
in  their  general  accuracy;  so  that  he  has  not  deemed  it  necessary  to 
make  many,  or  great  modifications. 

Throughout,  the  Author  has  adopted  the  nomenclature  of  the  last 
edition  of  the  Pharmacopoeia  of  the  United  States,  — a work,  which 
ought  to  be  in  the  hands  of  every  practitioner  as  a guide  in  the  pre- 
paration of  medicines  ; and  he  has  endeavoured  to  arrange  the  articles 
in  each  division,  as  nearly  as  he  could,  in  the  order  of  their  efficacy 
as  therapeutical  agents. 


CONTENTS  OE  VOL.  I 


CHAPTER  I. 

GENERAL  CONSIDERATIONS. 

Therapeutics  defined — Instinctive  action  of  recuperation — Importance  of 
bearing  it  in  mind  in  the  treatment  of  disease — Cure  by  sympathy — Ex- 
pectant Medicine — EflTorts  of  nature — Crises — Medical  experience — 
Science  of  medicine  demonstrative — Pre-eminence  of  therapeutics — The- 
rapeutical indications  vary  with  medical  theories — Necessity  of  dis- 
covering the  pathological  lesion — Rational  therapeutics  founded  on  rigid 
physiologico-pathological  deduction — Importance  of  discovering  the 
cause  of  the  lesion — Etiology  obscure — Empirics  and  Dogmatists — 
French  medical  school  of  observation — Numerical  methods — Necessity 
for  observation  and  reasoning — Haematology — Importance  of  principles 
in  Medicine  ........ 

CHAPTER  II. 

circumstances  that  modify  the  therapeutical  indications. 

Age — Sex — Original  conformation — Habit — Climate — Mental  affections — 
Professions,  and  way  of  life — Causes,  seat,  period,  &c.,  of  the  dis- 
ease ......... 

1.  Age  . 

2.  Sex  ........ 

3.  Original  Conformation  ..... 

4.  Habit  . * . . . 

5.  Climate  ....  ... 

6.  Mental  Affections  ...... 

7.  Professions,  and  Way  of  Life  .... 

8.  Causes,  Seat,  Period,  &c.,  of  the  Disease 

CHAPTER  III. 

OF  medicines. 

A medicine  defined — General  action  of  medicines — Various  modes  of  action 
— By  simple,  direct  or  local  action — By  indirect  or  general  action — 
Through  the  nerves — Through  absorption — Through  revulsion — Medi- 
cines divisible  into  Excitants  and  Sedatives — Classification  of  medicines 
— Barbier’s  Classification — A.  T.  Thomson’s  Classification  — Author’s 
Classification  ....... 

1.  Modus  Operand!  of  Medicines  ..... 

a.  By  Simple,  Direct,  or  Local  action 

b.  By  Indirect  or  General  Action  .... 

1.  Through  the  Nerves  ..... 

2.  Through  Absorption  ..... 

c.  Through  Revulsion  ..... 

2.  Classification  of  Medicines  ..... 


13 

37 

37 

39 

42 

50 

53 

57 

65 

67 

70 

71 

71 

72 

73 

76 

83 

83 


Vlll 


CONTENTS. 


SECTION  I. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  ALIMENTARY  CANAL,  OR  ITS 

CONTENTS. 

I.  Emetics. — Definition  of  emetics — Nauseants — ^Their  modus  operandi — 
Therapeutical  application — Physiology  of  vomiting — Modus  operandi  of 
emetics — Effects  on  the  stomach,  and  general  system — Evils  of  their  too 


frequent  employment — Therapeutical  application  of  emetics — Special 
emetics  ........  94 

1.  Nauseants  . . . . . . .95 

Therapeutical  application  of  Nauseants  ...  96 

II.  Emetics  .....  . . 97 

Therapeutical  application  of  Emetics  . . . 105 

Special  emetics  . - . . . . .114 

a.  Direct  Emetics  . . . . . .114 

h.  Indirect  Emetics  ......  115 


n.  CATHARTrcs. — Definition  of  cathartics — Effects  they  are  capable  of  in- 
ducing— Organs  on  which  they  act — Divided  into  laxatives  and  purga- 
tives— Drastics — Abuse  of  cathartics — Glysters — Suppositories — Thera- 
peutical application — In  fevers — In  inflammatory  disorders — In  hemor- 


rhage— In  the  neuroses — In  dropsies,  &c. — Special  cathartics  . 13*2 

Enemata  , . . . . . , . . 143 

Suppositories  .......  145 

Therapeutical  application  of  Cathartics  ....  146 

Special  Cathartics  ......  155 

I.  Laxatives  or  Mild  Cathartics  .....  155 

II,  Purgatives,  or  Brisk  Cathartics  . . . .163 

Saline  Cathartics  ......  184 

III.  Drastic  Cathartics  ......  191 


III.  Anthelmintics. — Definition  of  anthelmintics — Experiments  on  worms, 
out  of  the  body — Different  kinds  of  anthelmintics — True  anthelmintics 
— Mechanical  anthelmintics — Anthelmintics  that  expel  worms  by  acting 
on  the  intestinal  canal — Anthelmintics  that  prevent  the  formation  of 


worms — Ectozoa — Particular  Anthelmintics  * - - - 204 

1.  True  Anthelmintics  ------  205 

2.  Mechanical  Anthelmintics  -----  206 

3.  Anthelmintics  that  expel  worms  by  acting  on  the  intestinal  canal  206 

4.  Anthelmintics  that  prevent  the  formation  of  worms  - - 207 

Special  Anthelmintics  .-----  208 

I.  True  Anthelmintics  ------  208 

II.  Mechanical  Anthelmintics  -----  216 


SECTION  II. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  RESPIRATORY  ORGANS. 

Expectorants. — Definition  of  expectorants — Organs  on  which  they  act — 
Modus  operandi — Are  indirect  agents  only — Inhalalions^ — Special  Ex- 


pectorants - - - --  - - -218 

Inhalations  -------  221 

Special  Expectorants  222 

I.  Excitant  Expectorants  - - _ - - 222 

II.  Demulcent  Expectorants  235 

III.  Nauseant  and  Emetic  Expectorants  - - - - 249 

IV.  Topical  Expectorants — Inhalations  - - - - 249 

a.  Excitant  Inhalations  - - . . - 249 

b.  Sedative  Inhalations  255 


CONTENTS. 


IX 


SECTION  III. 


AGENTS  THAT  AFFECT  PROMINENTLY  THE  FOLLICULAR  OR  GLANDULAR  ORGANS. 

I.  Errhines.  — Definition  of  errhines  — Sternutatories — Modus  operand! 


— Dangers  of  sneezing — Special  errhines  . . . 256 

Therapeutical  application  of  Errhines  ....  257 

Special  Errhines  .......  258 

II.  SiALOGOGUES.  — Definition  of  Sialogogues  — Their  employment  limited 

— Modus  operand!  of  sialogogues  — Mercury  as  a sialogogue — Special 

sialogogues  .....••  261 

Therapeutical  application  of  Sialogogues  ....  261 

Special  Sialogogues  ......  2(  2 . 


III.  Diuretics.  — Definition  of  diuretics  — their  modus  operand!  — Men- 
tal diuretics  — Therapeutical  employment  of  diuretics  — In  dropsies  — 


In  various  chronic  diseases  — Special  diuretics  . . . 264 

Therapeutical  application  of  Diuretics  ....  268 

Special  Diuretics  . . . . . . 269 

I.  Excitant  Diuretics  ......  270 

II.  Sedative  Diuretics  . . . . . . 282 


IV.  Antilithics.  — Definition  of  antilithics,  and  of  lithonthryptics  — 


Calculous  diathesis  — Lithic  and  phosphaiic  diathesis  — Different  va- 
rieties of  calculus  — Therapeutical  application  of  antilithics  to  those 
varieties — Lithonthryptics  — Special  antilithics  . . 287 

1.  Antilithics  .....  . 287 

Therapeutical  application  of  Antilithics  . . . 290 

2.  Lythonthryptics  ......  293 

Special  Antilithics  ......  294 

1.  Acid  Antilithics  ......  294 

2.  Alkaline  Antilithics  .....  295 

3.  Tonic  Antilithics  ......  297 


V.  Diaphoretics.  — Definition  of  diaphoretics  — Largely  invoked  in 
Therapeutics. — Disease  not  often  induced  by  suppressed  perspiration 
— Modus  operand!  of  diaphoretics  — Are  indirect  agents  — How  their 


operation  may  be  aided  — Their  therapeutical  application  — Special 
Diaphoretics  . . ......  301 

Special  Diaphoretics  ......  308 

I.  Sedative  Diaphoretics  .....  308 

II.  Excitant  Diaphoretics  . . . . .313 

III.  Topical  Diaphoretics  ......  324 


SECTION  IV. 


AGENTS  THAT  AFFECT  PROMINENTLY  THE  NERVOUS  SYSTEM. 


I.  Narcotics.  — Definition  of  Narcotics  — May  be  used  as  excitants,  and 

as  sedatives  — Their  action  elpcidated  by  that  of  opium  — May  act 
locally  as  well  as  generally  — Mental  narcotics  — Therapeutical  appli- 
cation of  narcotics  — in  febrile  diseases— 'In  the  phlegmasiee,  &c. — 
Special  narcotics  ......  330 

Therapeutical  application  of  Narcotics  . . . ^ 342 

Special  Narcotics  ...  ...  344 

II,  Tetanics.  — Definition  — Modus  operand!  — Therapeutical  Applica- 
tion— Special  Tetanics  ......  382 

Special  Tetanics  ......  382 


X 


CONTENTS. 


111.  Antispasmodics.  — Definition  of  antispasmodics  — Spasm  considered 
— No  direct  antispasmodic  — Modus  operandi  of  the  indirect  mental 
antispasmodics  — Therapeutical  application  of  antispasmodics  in  te- 
tanus, chorea,  epilepsy,  asthma,  hooping  cough,  colic,  hysteria,  &c. 

— Special  antispasmodics  ......  388 

Therapeutical  application  of  Antispasmodics  . . 393 

Special  Antispasmodics  ......  39G 

1.  Excitant  Antispasmodics  ....  396 


SECTION  V. 

AGENTS  THAT  AFFECT  PROMtNENTLY  THE  ORGANS  OF  REPRODUCTION. 

I.  Emmenagogues.  — Definition  of  emmenagogues  — Modus  operandi  — 


No  direct  emmenagogues  — Special  emmenagogues  . . 405 

Special  Emmenagogues  ......  409 

I.  Cathartic  Emmenagogues  .....  409 

II.  Excitant  Emmenagogues  . . . . .411 

II.  Parturifacients. — Definition  of  parturifacients  — Most  of  them 
indirect  agents  — Often  destroy  the  mother  — Aristolochics  — Special 
parturients  . . . . . . 416 

Aristolochics  . . . . . . . 417 

Special  parturients  ......  417 


SECTION  VI. 

agents  that  affect  various  organs. 

I.  Excitants.  — Irritation,  not  debility,  the  great  lethiferous  agent  — 
Causes  of  death  in  cases  of  extensive  abscess,  phthisis  pulmonalis,  «fec. 
Debility  in  one  organ  may  suggest  irritation  in  another — Cases  of 
really  diminished  action  — Division  of  excitants  — Definition  of  ex- 
citants— Carminatives  — chiefly  derived  from  the  vegetable  kingdom 
— Simple  direct  action  of  excitants  — General  effect  of  excitants  — Ex- 
citement and  collapse  defined  — Excitants  act  also  as  revulsives  — 
Therapeutical  application  of  excitants  — In  gastric  and  intestinal  affec- 
tions — In  fevers  — In  inflammatory  diseases  — catarrhs  — In  the  neu- 
roses, hysteria,  epilepsy,  paralysis  — In  topical  inflammation  — Mental 
excitants  — Special  excitants  .....  423 

Therapeutical  application  of  Excitants  ....  429 

Special  Excitants  .......  439 


LIST  OF  ILLUSTRATIONS. 


FIG. 

1. 

2. 

3. 


4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

15. 

16. 

17. 

18. 

19. 

20. 
21. 
22. 

23. 

24. 

25. 

26. 

27. 

28. 
29. 

31. 

32. 

33. 

34. 

35. 

36. 

37. 


VOL.  I. 


PAGB 

Cephaelis  Ipecacuanha  . 117 

Brown  Ipecacuanha’root  . 117 

Striated  Ipecacuanha  root  — 
Undulated  Ipecacuanha 
root  . . . 119 

lonidium  Ipecacuanha  root  120 
Gilleniastipulacea . . 122 

Lobelia  inflata  . . 124 

Sanguinaria  Canadensis  • 128 

Apocynum  Androsaemifor- 

lium  . . . 129 

Erythronium  Americanura  130 
Euphorbia  corollata  . 131 

Ficus  Carica  . . 160 

Ricinus  communis  * 163 

Rheum  palmatum  . .165 

Rheum  compactum  . 165 

Aloe  Socotorina  . . 169 

Legume  and  leaflet  of  Acute 
leaved  Alexandrian  Senna  174 
Legume  and  leaflet  of  C.  obo- 
vata  . , . 174 

Tinnevelly  Senna  . . 175 

Cassia  Marilandica  . 177 

Podophyllum  . . 179 

Hebradendroncambogioides  194 
Momordica  Elaterium  . 200 

Apocynum  cannabinum  . 202 

Convolvulus  panduratus  . 203 

Chenopodium  anthelminti- 
cum  . . . 210 

Spigelia  Marilandica  . 211 

Nephrodium  Filix  mas  . 212 

Punica  granatum  . . 213 

30.  Inhaling  Bottles  . 221 
Balsamadendron  Myrrha  . 231 
Acacia  Arabica  . , 235 

Olea  Europsea  . . 239 

Saccharum  officinarum  - 241 
Linum  usitatissimum  . 243 
Astragalus  verus  . , 244 

Cetraria  Islandica  . . 246 


FIG.  PAGE 

38.  Fucus  vesiculosus  . . 248 

39.  Inhaler  . . . 252 

40.  Cantharides  . . 277 

41.  Leontodon  Taraxacum  . 279 

42.  Erigeron  Philadelphicum  . 282 

43.  Arbutus  Uva  ursi  . . 300 

44.  Eupatorium  perfoliatum  . 314 

45.  Asclepias  tuberosa  . 322 

46.  Arum  triphyllum  . . 323 

47.  Carthamus  tinctorius  . 324 

48.  Warm-bath  . . 328 

49.  Hip-bath  . . , 328 

50.  Foot-bath  . . . 329 

51.  Hyoscyamus  niger  . 359 

52.  Datura  Stramomium  . 365 

53.  Conium  maculatum  . 367 

54.  Humulus  Liipulos  . . 376 

55.  Dried  lupulinic  grain  with 

its  hilum  magnified  . 377 

56.  Cannabis  sativa  . . 378 

57.  Lycopus  Virginicus  . 381 

58.  Strychnos  Nux  vomica  . 383 

59.  Ruta  graveolens  . .414 

60.  Secale  cornutum  . . 418 

61.  Cinnamomum  Zeylanicum  439 

62.  Cardamom  . . . 444 

63.  Caryophyllus  aromaticus  . 444 

64.  Fceniculum  vulgare  . 446 

65.  Monarda  coccinea  . . 448 

66.  Hedeoma  pulegioides  . 449 

67.  Myristica  moschata  . 450 

68.  Nutmeg  in  the  shell  sur- 

rounded by  the  mace  . 450 

69.  Gaultheria  procumbens  . 455 

70.  Juniperus  communis  . 456 

71.  Citrus  Aurantium  . . 458 

72.  Laurus  Camphora  . 459 

73.  Drymis  Winter!  . . 463 

74.  Acorus  Calamus  . . 464 

75.  Piper  nigrum  . . 465 


76.  Electrical  Apparatus  for 

Medical  purposes  . 499 


LIST  OF  ILLUSTRATIONS. 


VOL.  II. 


FIG. 

PAGE 

1.  Cocculus  palmatus.  (Male 

plant.)  . 

30 

2.  Gentiana  Catesbsei 

33 

3.  Frasera  Walter! 

37 

4.  Sabbatia  angularis . 

38 

5.  Coptis  trifolia 

38 

6.  Aletris  farinosa  , 

39 

7.  Aristolochia  serpentaria 

42 

8.  Asarum  Canadense 

45 

9.  Anthemis  Cotula  . 

46 

10.  Magnolia  glauca  . 

47 

11.  Magnolia  macrophylla 

47 

12.  Geum  Virginianum 

48 

13.  Hepatica  Americana 

49 

14.  Indigo 

51 

15.  Cornus  Florida 

87 

16.  Liriodendron  tulipifera 

88 

17.  Diospyros  Virginiana 

129 

18.  Heuchera  acerifolia 

130 

19.  Spiraea  tomentosa  . 

131 

20.  Statice  Caroliniana 

132 

21.  Colchicum  autumnale 

189 

22.  Veratrum  Album.  Var. 

Albiflorum 

194 

23.  Cimicifuga  racemosa 

196 

FIG. 

PAGE 

24. 

25.  Shower-bath  . 

208 

26. 

Abies  excelsa 

358 

27. 

Rananculus  acris  . 

266 

28. 

Aralia  nudicaulis  . 

348 

29. 

Solanum  dulcamara 

349 

30. 

Tacca  pinnatifida  . 

392 

31. 

Particles  of  Tahiti  Arrow- 

root 

393 

32. 

Particles  of  white  East 

India  Arrow-root 

393 

33. 

Particles  of  West  India 

Arrow-root 

393 

34. 

Particles  of  Tous-les-mois 

394 

35. 

Particles  of  Potato  starch 

seen  by  the  microscope  . 

394 

36. 

Janipha  Manihot  . 

395 

37. 

Particles  of  Tapioca  as 

seen  by  the  microscope  . 

395 

38. 

Sagus  Rumphii 

395 

39. 

Particles  of  sago  meal 

396 

40. 

Particles  of  potato  sago 

396 

41. 

Cycas  revoluta  or  the  Japan 

Sago-tree 

396 

42. 

Avena  sativa 

397 

43. 

Particles  of  Wheat  starch 

398 

N.B.  The  figures  of  indigenous  plants  are  chiefly  from  Rafinesque, 


GENERAL  THERAPEUTICS 


AXD 

MATERIA  M E D I CA. 


CHAPTER  I. 

GENERAL  CONSIDERATIONS. 

Therapeutics  defined — Instinctive  action  of  recuperation — Importance  of  bearing  it  in 
mind  in  the  treatment  of  disease — Cure  by  sympathy — Expectant  medicine — Efforts 
of  nature — Crisis — Medical  experience — Science  of  medicine  demonstrative — Pre- 
eminence of  therapeutics — Therapeutical  indications  vary  with  medical  theories — 
Necessity  of  discovering  the  pathological  lesion — Rational  therapeutics  founded  on  rigid 
physiol ogico-pathological  deduction — Importance  of  discovering  the  cause  of  the  lesion 
— Etiology  obscure — Empirics  and  Dogmatists — French  Medical  School  of  Observation 
— Numerical  methods — Necessity  for  observation  and  reasoning — Haematology — Im- 
portance of  principles  in  medicine. 

Therapeutics  is  the  branch  of  Medical  Science  which  comprises 
the  doctrine  of  the  management  of  disease.  Generally,  however,  the 
term  is  restricted  to  a description  of  the  modus  operandi  of  medi- 
cines ; and  the  department  is  commonly  associated,  in  our  Institu- 
tions, with  Materia  Medica ; whilst  the  Practice  of  Physic  is  confided 
to  a distinct  Professor.  Under  this  division.  General  Theurapeutics 
is  made  to  embrace  the  principles  of  medicinal  administration,  and 
the  indications,  which  the  different  articles  of  the  Materia  Medica 
are  capable  of  fulfilling,  whilst  the  Chair  of  Practice  is  appropriated, 
so  far  as  regards  Therapeutics,  to  the  application  of  those  principles 
to  particular  morbid  conditions,  or  to  what  has  been  called  Special 
Therapeutics.  It  is  the  business  of  the  physiologist  to  investigate 
the  functions  of  healthy  man  ; the  pathologist  regards  those  functions 
in  disease,  and  the  therapeutist  endeavours  to  restore  them  from  the 
latter  to  the  former  condition. 

There  is  no  branch  of  medicine  with  which  the  therapeutist  ought 
not  to  be  acquainted.  To  be  a good  therapeutist  requires  not  only 
that  he  shall  have  had  extensive  opportunities  for  witnessing  disease, 
VOL.  I. — 2 


14 


GENERAL  CONSIDERATIONS. 


but  shall  have  read  extensively  the  recorded  observations  of  others^ 
It  demands,  too,  the  utmost  powers  of  discrimination  ; — hence,  the 
varied  knowledge,  which  the  physician  ought  to  possess,  and  the 
learning  and  dignity  of  the  science. 

It  might  be  imagined,  that  lectures  on  Therapeutics  are  unneces- 
sary, where  the  mode  of  managing  individual  diseases  is  given  from 
the  Chair  of  Practice  ; in  the  latter  case,  however,  the  principles  are* 
necessarily  diffused  — not  sufficiently  embodied  — and,  moreover,  the 
teacher  generally  presumes,  that  the  student — which  rarely  happens 
— is  imbued  with  the  great  principles  and  rules,  that  apply  to  the 
administration  and  modus  operandi  of  medicines. 

In  the  state  of  health  the  various  functions  are  executed  in  a regular 
and  harmonious  manner,  and  are  intimately  connected  by  consent  or 
sympathy  ; but  if  a morbific  cause  impresses  the  organism,  this  har- 
monious condition  is  disturbed  ; a fresh  series  of  actions  results,  and 
disorder  supervenes. 

Physiologists  have  noticed  in  every  living  body  an  instinctive 
action  — an  action  of  the  living  principle,  whenever  manifestly  direct- 
ing its  operations  to  the  health,  preservation,  or  reproduction  of  a 
living  frame,  or  of  any  part  of  it.  This  applies  to  the  plant  as  well 
as  to  the  animal.  It  is  the  vis  medicatrix  naturce,  for  and  against 
which  so  much  has  been  said  ; but  which  — if  restricted  to  the  opera- 
tion we  have  mentioned  — can  no  more  be  denied  than  the  existence 
of  life,  of  which  we  know  nothing  except  by  its  results.  It  is  strik- 
ingly witnessed  in  the  reparatory  power  exerted  by  living  bodies 
after  the  receipt  of  an  injury.  If  we  tear  a branch  from  a tree,  we 
find,  that  the  injury  done  to  the  parent  trunk  is  repaired  by  an  action 
analogous  to  that  set  up  by  the  animal  whenever  a wound  is  inflicted 
upon  it.  In  some  vegetables,  the  reparatory  power  is  so  energeti- 
cally exerted,  that  lost  parts  are  restored  ; and  it  is  upon  this 
power  that  the  utility  of  certain  garden  vegetables — spinach,  parsley, 
cress,  &c.  — reposes.  Such  a reparatory  power  is  occasionally  — 
but  rarely  — met  with  in  the  animal  kingdom.  We  see  it  in  the 
lobster  deprived  of  its  claw,  and  in  the  serpent  that  has  lost  its  tail. 
The  nails  and  hair,  too,  regain  their  accustomed  length  when  cut, 
and  the  same  thing  happens  to  the  teeth  of  the  Rodentia  or  gnawers. 

Few  animals,  however,  possess,  to  any  extent,  the  power  of  restor- 
ing lost  parts  ; but  all  are  capable  of  repairing  injuries,  and  of  remov- 
ing disease,  when  it  is  within  certain  limits.  In  cases  of  wounds,  and 
broken  bones,  the  efforts  of  the  surgeon  are  chiefly  restricted  to  keep- 
ing the  parts  in  apposition,  and  to  preventing  the  intrusion  of  internal 
and  extraneous  irritants,  whilst  his  reliance  is  placed  on  those  sana- 
tive powers  that  are  seated  in  the  wounded  part,  as  in  every  part  of 
the  living  frame.  It  is  to  this  power  that  we  ascribe  all  the  proper- 
ties assigned  to  the  cure  by  sympathy,  which,  at  one  time,  excited 
so  much  attention,  was  promulgated  by  the  Rosicrucians,  and  ob- 
tained universal  credence  in  the  seventeenth  century.  This  consisted 
in  applying  dressings,  in  the  case  of  wounds,  not  to  the  injured  parts, 


GENERAL  CONSIDERATIONS. 


15 


V)ut  to  the  weapon  that  inflicted  them.  The  sympathetic  powder  of 
Sir  Kenelm  Digby  was  an  application  of  this  nature,  which  enjoyed 
the  most  astonishing  reputation.  It  was  first  employed  at  Florence, 
in  the  commencement  of  the  seventeenth  century,  by  a Carmelite 
monk,  who  had  just  returned  from  India.  The  grand  duke,  hear- 
ing of  the  monk’s  marvellous  cures,  asked  him  for  his  secret,  which 
he  refused,  fearing  that  the  duke  might  divulge  it.  Some  time  after- 
wards, Sir  Kenelm,  having  rendered  an  important  service  to  the 
monk,  the  latter,  out  of  gratitude,  communicated  to  him  the  compo- 
sition of  the  powder,  and  Sir  Kenelm  took  the  secret  with  him  to 
England.  An  opportunity  soon  occurred  for  testing  its  properties. 
A Mr.  Howell,  having  been  wounded  in  attempting  to  separate  two 
of  his  friends,  who  were  engaged  in  a duel,  was  subjected  to  its  em- 
ployment. Four  days  after  the  infliction  of  the  wound.  Sir  Kenelm 
dipped  one  of  Mr.  Howell’s  garters  in  a solution  of  the  powder,  and 
immediately  — it  is  asserted — the  wound,  which  was  previously  pain- 
ful, became  easy,  but  as  the  garter  grew  dry,  the  pains  returned,  and 
were  relieved  by  a fresh  immersion  of  the  garter  in  the  solution.  In 
five  or  six  days,  the.  wound  healed.  James  the  First;  his  son — after- 
wards Charles  the  Second ; the  Duke  of  Buckingham,  and  all  the 
principal  personages  about  the  court,  were  acquainted  with  the  cir- 
cumstances of  the  case  ; and  James  — whose  enthusiasm  was  not 
counterbalanced  by  much  judgment,  and  who  was,  withal,  supersti- 
tious in  the  highest  degree  — obtained  the  secret  from  Sir  Kenelm, 
and  performed  most  astonishing  cures.  In  no  great  length  of  time 
the  composition  transpired,  and,  as  in  all  like  cases,  the  charm  eva- 
porated with  the  disclosure.  The  powder,  employed  by  Sir  Kenelm, 
is  asserted  to  have  been  sulphate  of  copper,  prepared  in  a particular 
manner.  Some  affirm  it  to  have  been  the  ordinary  green  vitriol  of 
commerce. 

Dryden  alludes  to  the  superstition  more  than  once  in  his  Tem^ 
pestj  or  Enchanted  Island^'*  Thus,  Ariel: 

When  I was  chidden  by  my  mighty  lord, 

For  my  neglect  of  young  Hippolito, 

I went  to  view  his  body,  and  soon  found 
His  soul  was  but  retired,  not  sallied  out ; 

Then  I collected 

The  best  of  simples  underneath  the  moon. 

The  best  of  balms,  and  to  the  wound  applied 
The  healing  juice  of  vulnerary  herbs. 

His  only  danger  was  his  loss  of  blood  ; 

But  now  he’s  waked,  my  lord,  and  just  this  hour 
He  must  be  dress’d  again,  as  I have  done  it. 

Anoint  the  sword,  which  pierced  him,  with  this  weapon  salve,  and  wrap 
it  close  from  air,  till  I have  time  to  visit  him  a^ain.” 

Act  V.  scene  2d. 

And  : — Miranda,  when  she  enters  with  Hippolito’s  sword  wrapped 
up: 


16 


GENERAL  CONSIDERATIONS. 


“ Hip,  0,  iny  wounds  pain  me  ! 

[.S'Ae  nnivrups  the  suord.l 

“ Mir.  I am  come  to  ease  you. 

“ Hip.  Alas  ! I feel  the  cold  air  come  to  me: 

My  wound  shoots  worse  than  ever. 

[iS/je  'ivipes  and  anoints  the  sivvrd.'\ 

“ Mir.  Does  it  still  grieve  you  ? 

“ Hip.  Now  methinks  there’s  something 
]jai(l  just  upon  it. 

“ jMir.  Do  you  find  no  ease  1 
“ Hip.  Yes.  Yes:  upon  the  sudden  all  this  pain 
Is  leaving  me  — Sweet  Heaven,  how  I am  eased  I” 

Jict  v.  scene  2d. 

It  is  likewise  referred  to  in  the  third  Canto  of  the  “ Lay  of  the 
Last  Minstrel  f of  Sir  Walter  Scott. 

The  sympathetic  ointments,  applied  to  the  weapon,  or  the  “ arma- 
tory  unguents,”  as  they  were  termed,  were  of  various  characters,  con- 
taining the  most  absurd,  disgusting,  and  often  inert  ingredients.  The 
following  extract  from  the  “ Sylva  Syl varum”  or  “ Natural  History” 
of  Lord  Bacon,  strikingly  exhibits  this.  The  mode  of  managing  the 
wound  sufficiently  accounts  for  the  good  effects  ascribed  to  the  cure 
by  sympathy.  ‘‘  It  is  constantly  received  and  avouched,  that  the 
anointing  of  the  weapon  that  maketh  the  w^ound  will  heal  the  wound 
itself.  In  this  experiment,  upon  the  relation  of  men  of  credit,  though 
myself,  as  yet,  am  not  fully  inclined  to  believe  to  it,  you  shall  note 
the  points  following:  First,  the  ointment,  wdth  which  this  is  done,  is 
made  of  divers  ingredients  ; whereof  the  strangest  and  hardest  to 
come  by  are  the  moss  upon  the  skull  of  a dead  man  unburied,  and 
the  fats  of  a boar  and  a bear  killed  in  the  act  of  generation.  These 
two  last  I could  easily  suspect  to  be  prescribed  as  a starting  hole, 
that  if  the  experiment  proved  not,  it  might  be  pretended,  that  the 
beasts  were  not  killed  in  the  due  time  ; for  as  for  the  moss,  it  is 
certain  there  is  great  quantity  of  it  in  Ireland  upon  slain  bodies, 
laid  in  heaps  unburied.  The  other  ingredients  are  the  blood- 
stone in  powder,  and  some  other  things,  which  seem  to  have  a 
virtue  to  stanch  blood  ; as  also  the  moss  hath.  And  the  descrip- 
tion of  the  whole  ointment  is  to  be  found  in  the  chymical  dispen- 
satory of  Crollius.  Secondly,  the  same  kind  of  ointment  applied 
to  the  part  itself  worketh  not  the  effect,  but  only  applied  to  the  wea- 
pon. Thirdly,  which  I like  W’ell,  they  do  not  observe  the  confect- 
ing of  the  ointment  under  any  certain  constellation,  which  commonly 
is  the  excuse  of  magical  medicines  wffien  they  fail,  that  they  were 
not  made  under  a fit  figure  of  heaven.  Fourthly,  it  may  be  applied 
to  the  weapon,  though  the  party  hurt  be  at  a great  distance.  Fifthly, 
it  seemeth  the  imagination  of  the  party  to  be  cured  is  not  needful  to 
concur  ; for  it  may  be  done  without  the  knowledge  of  the  party 
wounded  ; and  thus  much  has  been  tried,  that  the  ointment,  for  ex- 
periment’s sake,  hath  been  wiped  off  the  weapon,  without  the  know- 
ledge of  the  party  hurt,  and  presently  the  party  hurt  has  been  in 
great  rage  of  pain,  till  the  weapon  was  re-anointed.  Sixthly,  it  is 


CxENERAL  CONSIDERATIONS. 


17 


affirmed,  that  if  you  cannot  get  the  weapon,  yet  if  you  put  an  instru- 
ment of  iron  or  wood,  resembling  the  weapon,  into  the  wound, 
whereby  it  bleedeth,  the  anointing  of  that  instrument  will  serve  and 
work  the  effect.  This  I doubt  should  be  a device  to  keep  this  strange 
form  of  cure  in  request  and  use,  because  many  times  you  cannot 
come  by  the  weapon  itself.  Seventhly,  the  wound  must  he  at  first 
washed  clean  xcith  white  wine ^ or  the  party’’ s own  water;  and  then 
bound  up  close  in  fine  linen ^ and  no  more  dressing  renewed  till  it  he 
luhole.  Eighthly,  the  sword  itself  must  be  wrapped  up  close,  as  far 
as  the  ointment  goeth,  that  it  taketh  no  wind.  Ninthly,  the  oint- 
ment, if  you  wipe  it  off  from  the  sword  and  keep  it,  will  serve  again, 
and  rather  increase  in  virtue  than  diminish.  Tenthly,  it  will  cure  in 
far  shorter  time,  than  ointments  of  wounds  commonly  do.  Lastly,  it 
will  cure  a beast  as  well  as  a man,  which  1 like  best  of  all  the  rest, 
because  it  subjecteth  the  matter  to  an  easy  trial.” 

The  lines,  in  the  above  quotation,  marked  in  italics,  are  the  key 
to  the  solution  of  the  whole  mystery.  It  is,  indeed,  the  practice, 
adopted  at  the  present  day,  in  the  treatment  of  incised  wounds,  and 
to  this  — not  to  the  influence  of  the  sympathetic  powder,  or  armatory 
unguent  — it  need  hardly  be  said  — must  the  main  curative  agency 
be  ascribed,  whilst  a portion  may  be  assigned  to  the  mental  revul- 
sion produced  on  the  sufferer,  through  his  faith  in  the  virtues  ascribed 
to  the  application.  The  wound  was  carefully  defended  from  the 
irritation  of  extraneous  substances,  and  given  up  to  that  instinctive 
principle,  which,  we  have  seen,  repairs  the  injuries  to  which  or- 
ganized bodies  are  liable  ; and  it  has  been  suggested,  that  the  re- 
sults furnished  the  first  hint  which  led  surgeons  to  the  improved  prac- 
tice of  healing  wounds  by  what  is  technically  called — the  first  in- 

tention.” 

The  existence,  then,  of  such  an  instinctive  power  can  neither  be 
denied  nor  lost  sight  of  in  the  treatment  of  disease.  The  error  has 
been,  that  undue  weight  has  been  attached  to  it,  so  that  the  practi- 
tioner was  altogether  guided  by  its  manifestations — or  fancied  ma- 
nifestations— in  laying  down  his  indications  of  cure  ; and  if  no  such 
manifestation  existed,  he  waited  vainly — and  too  often  most  unfor- 
tunately— until  the  time  had  perhaps  gone  by  for  the  successful 
administration  of  efficacious  agents.  To  this  system  of  ‘^wait- 
ing, or  expecting”  the  term  medicina  expectans — la  medecine  expeC'> 
tante — was  appropriated.  The  followers  of  Stahl — the  great  apostle 
of  the  doctrine  — supposed  a power  to  be  present  in  the  system  of 
repelling  morbific  influences,  and  of  re-establishing  equilibrium  when 
disturbed.  There  are  but  few  cases,  however,  in  which  trust  can  be 
safely  placed  in  this  power.  It  too  often  happens,  that  diseased  action 
in  a tissue  or  organ  goes  on  augmenting,  until  the  functions  of  other 
tissues  and  organs  become  deranged  by  sympathy,  and  disorganiza- 
tion and  death  follow.  Yet  the  doctrine  of  Stahl  is  still  maintained 
by  many  practitioners  — of  the  old  world  more  especially  ; and,  by 
many  who  reject  it,  terms  are  frequently  employed,  which  may  be 
2* 


18 


GENERAL  CONSIDERATIONS. 


regarded  as  its  relics.  We  often  hear,  for  example,  of  efforts  of 
nature,”  yet  the  ideas  attached  to  the  expression  are  very  imprecise. 
If  a diarrhoea  should  supervene  about  the  favourable  termination  of 
a protracted  fever,  it  is  looked  upon  as  “ critical  — as  a hencfice  de 
ventre j or  a benefice  de  la  nature  ; but  if,  on  the  other  hand,  diarrhoea 
supervenes  in  phthisis  pulmonalis,  as  an  accompaniment  of  the  hec- 
tic fever,  proves  colliquative,  and  hastens  dissolution,  we  hear  no- 
thing of  its  being  an  effort  to  disembarrass  the  economy — or  of  its 
constituting  a crisis.  If,  again,  an  individual  have  suffered  under 
headache,  giddiness  and  other  symptoms  of  uneasiness  about  the 
head,  and  epistaxis  take  place,  after  which  the  symptoms  are  re- 
moved or  mitigated,  the  hemorrhage  is  regarded  as  an  effort  of 
nature,  although  it  was  doubtless  dependent  upon  the  same  patholo- 
gical condition  that  gave  rise  to  the  headache  and  the  other  symp- 
toms ; but  if  the  hemorrhage  occur  to  such  an  extent  as  to  excite 
alarm,  or  to  prove  fatal,  nothing  is  said  of  its  being  an  effort  of  na- 
ture. In  the  same  manner,  if  hemorrhage  occur  in  the  brain  or  in 
the  lungs  we  rarely  or  never  hear  this  mode  of  accounting  for  it. 

Yet,  although  we  may  discard  the  notion  of  efforts  of  nature, 
there  is  no  doubt,  that  good  occasionally  results  from  spontaneous 
discharges,  and  that,  at  other  times,  their  supervention  indicates  a 
change  in  functions  which  may  have  been  long  disordered,  and  a 
restoration  to  the  healthy  condition.  Thus,  where  polysemia  or  ple- 
thora exists  in  the  vessels  generally,  or  in  some  portion  of  the  eco- 
nomy, the  supervention  of  moderate  hemorrhage  may  diminish  the 
intensity  of  the  cause  ; and  diarrhoea,  or  perspiration  supervening  in 
a fever  of  some  duration,  in  which  the  functions  of  secretion  have 
been  disordered,  may  indicate,  that  the  organs  of  secretion  are  as- 
suming a new  condition,  and  that  the  morbid  catenation,  previously 
existing,  is  beginning  to  disappear.  Although,  therefore,  we  may 
not  be  justified  in  regarding  such  discharges  as  indicating  any  effort 
of  nature,  they  may  be,  and  doubtless  frequently  are,  salutary. 

An  attention  to  these  topics  will  lead  to  the  combating  of  irregu- 
larities when  they  occur  in  the  organic  actions,  provided  they  are 
beyond  the  due  point ; and,  at  the  same  time,  teach  us  not  to  interfere 
too  much  with  the  instinctive  actions,  provided  they  seem  to  be 
going  on  favourably.  The  therapeutist  must  be  guided,  however, 
by  observation  and  reflection  as  to  his  rule  of  conduct  in  each  case. 
In  the  very  complex  operations  of  the  animal  frame,  the  relation 
between  cause  and  effect  is  not  always  readily  appreciable;  great 
caution  is,  therefore,  necessary  on  the  part  of  the  observer,  lest,  in 
place  o^  facts  — properly  so  called  — he  should  register  such  as 
have  been  termed  — not  inappropriately  — “false.”  Should  he  incur 
this  error,  owing  either  to  the  intrinsic  diffculty  of  the  subject,  or  to 
his  incompetency  as  an  observer,  a foundation  may  be  laid  for  other 
erroneous  observations  and  deductions,  and  experience  may  thus  be 
acquired;  but  it  is  experience,  in  its  sequel,  most  unfortunate.  'The 
public  are,  unhappily,  too  apt  to  be  led  away  by  this  idea  of  experi- 


GENERAL  CONSIDERATIONS. 


19 


ence;  erroneously  believing  that  all  are  capable  of  profiting  by  it, 
and,  consequently,  that  every  one  who  has  been  sufficiently  long 
engaged  in  the  pursuit  of  his  profession  must  necessarily  be  experi- 
enced and  wise.  Were  all  men  equally  attentive  and  equally  gifted 
wdth  adequate  powers  of  observation  and  reflection,  the  deduction 
would  be  just;  but  this  is  by  no  means  the  case.  If  a man  cannot 
observe  and  reason  on  topics  of  a general  nature,  he  cannot  on  such 
as  appertain  to  medicine ; and,  accordingly,  the  best  rule  for  esti- 
mating the  abilities  of  the  physician  by  the  unprofessional  is  by 
examining  into  the  character  of  his  mind,  his  modes  of  reasoning, 
his  degree  of  mental  application,  and  his  general  qualifications.  A 
man  of  ordinary  mind,  application,  and  attainments,  may  register  a 
few  facts;  and,  by  comparing  them  together,  may  deduce  useful 
inferences  so  far  as  these  facts  may  permit,  and  in  this  way  may 
prescribe  sufficiently  well  in  ordinary  cases;  but  such  cases  are  not 
the  touchstone  of  knowledge.  In  the  multitude  of  trying  cases  that 
present  themselves  to  every  practitioner,  in  the  course  of  his  career, 
what  painful  anxiety  is  felt  by  him,  if  he  be  well  informed  in  his 
profession,  and,  withal,  a philanthropist!  What  careful  comparison 
of  his  own  experience  with  the  recorded  experience  of  others! 
What  an  amount  of  physico-moral  reflection  before  he  decides! 
Perhaps  in  no  other  profession  or  calling  are  the  intellectual  and 
moral  feelings  so  much  enlisted;  but  what  consolation  awaits  the 
physician,  if  he  can  feel  satisfied,  that  the  result,  at  which  he  has 
arrived,  accords  with  the  demands  of  the  case,  — that  the  decision  is 
adequate  to  the  emergency!  These  are  cases  in  which  ignorance  is 
bliss,  but  how  fearful  the  responsibility  of  such  ignorance!  Views, 
like  these,  have  given  occasion  to  legislative  enactments  — 'which  are 
every  where  too  inoperative  — to  protect  the  public  against  the  igno- 
rant, the  mercenary,  and  the  — too  often  — unprincipled  pretender. 
The  curriculum  of  study,  required  in  the  different  Medical  Colleges, 
has  been  suggested  by  a wise  care  for  the  lives  and  the  health  of  the 
public,  and  such  a period  of  attendance  upon  the  lectures  that  con- 
stitute it  has  been  prescribed  as  may  enable  the  industrious  — even 
if  not  highly  gifted  — to  qualify  themselves  for  entering  upon  the 
broad  field  of  observation,  and  of  extended  usefulness  into  which 
their  avocation  may  carry  them.  It  is  within  collegiate  walls,  that 
the  student  acquires  the  prominent  facts  of  his  profession,  and  the 
great  principles  appertaining  to  its  practical  administration.  He 
there  learns  the  theory  on  which  all  sound  and  rational  practice  is 
based.  Too  often,  amongst  the  uninformed,  the  theoretical  and  the 
practical  pursuit  of  a calling  are  placed  in  unworthy  contrast.  In 
no  art  can  sound  practice  exist  without  theory.  Theory  is  the  mental 
process,  which  binds  observed  facts  together;  compares  them  with 
each  other,  and  deduces  appropriate  rules  of  practice.  Very  different 
is  this  from  the  hypothesis  that  emanates  from  assumptions  not 
proved.  It  is  to  theory  — as  above  defined  — and  as  it  is  now  under- 
stood every  where  amongst  the  scientific,  that  we  are  indebted  not 


20 


GENERAL  CONSIDERATIONS. 


only  for  full  practical  usefulness,  but  for  every  science.  Facts  are, 
doubtless,  the  elements  of  science,  but  the  science  itself  does  not 
exist,  until  these  facts  have  been  brought  together,  sifted  and  com- 
pared, and  great  general  principles  deduced  therefrom. 

In  such  sifting  and  comparison,  a multitude  of  miscalled  facts  have 
to  be  discarded.  In  the  science  of  medicine  — in  every  science  — 
those  that  merit  the  epithet  false  are  numerous,  and  many  of  them 
rest  on  the  authority  of  the  heedless  observer,  who  arrives  at  his 
conclusions  without  due  examination.  The  theoretical  investigation 
of  science  renders  a man  cautious  even  to  scepticism.  Very  few, 
therefore,  of  the  mass  of  recorded  facts  originate  with  him : he  has 
little  to  do  in  accumulating  the  chaff  that  envelopes  the  grain.  The 
records  of  the  Patent  Office  of  every  country  tend  to  elucidate  this 
matter.  It  has  been  properly  observed,  that  every  patent  is  a specu- 
lation. Who,  then,  are  the  great  speculators?  Not  the  theoretical 
men,  in  the  sense  in  which  we  have  used  the  term,  but  what  are 
called  practical  men,  — men,  who  narrow  themselves  down  to  ob- 
served facts  in  their  own  profession  or  calling,  and  who,  in  conse- 
quence of  their  ignorance  of  theory,  soon  find  that  their  inventions 
are  no  important  additions  to  existing  knowledge.  A writer  on  this 
subject  asserts,  that  he  has  made  a rough  estimate  of  the  number  of 
scientific  persons  who  have  published  works  relative  to  new  inventions 
in  arts,  and  he  finds,  that  in  Europe  they  did  not  exceed  two  hundred 
during  the  whole  of  the  last  century,  whilst  there  are  not  fewer  than 
that  number  of  patents  taken  out  in  England  annually.  An  adequate 
acquaintance  with  scientific  truths  would  prevent  this  waste  of  time 
and  of  talent ; and  hence  it  is,  that  in  every  science  or  art,  a combi- 
nation of  theoretical  and  practical  knowledge  is  necessary  to  lead  to 
lofty  and  enduring  results.  This  is  the  great  improvement  in  the 
modern  method  of  teaching  the  practical  sciences.  That,  which  was 
formerly  oracularly  delivered  from  the  chair  as  the  result  of  the  ex- 
perience of  the  master,  is  not  now  promulgated  as  indisputable.  It 
is  placed  before  the  inquirer  as  a fact,  over  and  over  again  examined 
and  scrutinized,  and  the  reasons  for  any  opinion  are  fairly  stated  as 
elements  for  his  decision.  The  time  has  passed  away,  when  the 
human  mind  is  to  credit  the  mere  verha  magistri^  or  to  place  implicit 
credence  in  a scientific  assertion,  without  examination,  because  it 
proceeds  from  this  or  that  individual.  The  rule  of  conduct,  implied 
in  the  language  of  the  Roman  Satirist,  — “ Marcus  dixit,  ita  est.  ” — 

“ Did  Marcus  say  ’twas  fact  1 then  fact  it  is  : 

No  proof  so  valid  as  a word  of  his” — 

has  been  too  much  inculcated  in  all  ages,  and  no  science  has  suffered 
so  much  from  it  as  medicine.  It  has  been  properly  remarked  by  Dr. 
Abercrombie,  in  his  ‘‘  Inquiries  concerning  the  intellectual  powers 
and  the  investigation  of  truth,”  that  in  receiving  facts  on  the  testi- 
mony of  others,  we  require  to  be  satisfied  not  only  of  the  veracity  of 
the  narrators,  but  also  of  their  habits  as  philosophical  observers,  and 


GENERAL  CONSIDERATIONS. 


21 


of  the  opportunities,  which  they  have  had  of  ascertaining  the  facts. 
In  receiving  affirmed  truths,  therefore,  the  inquirer  has  to  exercise 
caution ; but  at  the  same  time  to  be  careful  lest  by  attempting  to 
avoid  one  error  he  may  incur  another,  and  may  pass  from  credulity 
to  ill-judged  scepticism,  — extremes,  which  the  mind,  anxious  after 
truth,  will  carefully  avoid. 

In  the  management  of  disease  it  is  not  always  necessary  that  drugs 
should  be  given,  unless  their  use  is  clearly  indicated  ; or  unless  in 
the  case  of  certain  nervous  and  impressible  individuals,  whose  faith 
is  not  reposed  in  any  system  of  medication,  that  does  not  include  the 
use  of  internal  medicines.  To  obtain  this  faith  is  an  important  desi- 
deratum, as  will  be  seen  hereafter,  in  the  treatment  of  many  diseases, 
of  a nervous  character  especially.  The  physician  exhibits  his  skill 
better  by  controlling  disease  by  appropriate  regimen  than  by  admi- 
nistering combinations  of  whose  effects  he  often  knows  little,  and 
where  much  of  his  practice  must  necessarily  be  involved  in  conjec- 
ture. The  science  of  medicine  is  more  demonstrative  than  is  usually 
imagined,  and,  where  the  case  is  not  so,  the  practitioner  had  better 
for  the  time  do  nothing.  Any  experiment  may  have  one  of  two 
opposite  results : it  may  do  good,  or  harm ; and  hence,  a practitioner  is 
not  justified  in  administering  a powerful  medicinal  agent  at  random. 
If  he  be  desirous  of  instituting  experiments,  he  ought  to  take  exam- 
ple from  some  modern  therapeutical  inquirers  in  Germany,  and  make 
them  upon  himself,  rather  than  upon  his  patients.  It  cannot  often 
happen,  however,  that  the  physician  is  at  a loss  what  course  to  pur- 
sue. His  physiological  and  pathological  knowledge  will  indicate 
what  ought  to  be  the  great  principles  of  management;  and  his  ac- 
quaintance with  the  remedial  virtues  of  the  different  articles  of  the 
materia  medica  will  suggest  the  proper  agents  for  carrying  those  prin- 
ciples into  action. 

To  elucidate  this,  the  case  of  the  drug  opium  may  be  taken.  It  is 
known  that  it  will  allay  irritation,  and  produce  sleep;  a knowledge 
acquired  from  observation.  It  is  known  also,  that  in  a large  dose  it 
is  sedative  ; in  a small  dose  stimulant.  When  a case  of  inflammation 
occurs,  we  are  not  deterred  from  its  use,  because  it  excites  in  a small 
dose,  but  give  it  in  a quantity  sufficiently  large  to  insure  the  sedative 
operation.  Accordingly,  observation  and  reflection  have  led  to  the 
employment  of  this  useful  drug  in  cases  where  the  practitioner,  a few 
years  ago,  would  not  have  ventured  upon  it.  It  is  by  empirical 
trials,  that  we  become  informed  of  the  properties  of  any  medicinal 
agent,  after  which  sound  physiological  and  pathological  knowledge 
suggest  its  correct  application. 

The  great  object  of  the  science  of  medicine  is  to  remove  disease. 
Hence  the  pre-eminent  importance  of  Therapeutics.  It  has  been 
largely  modified  by  prevalent  systems  or  doctrines,  yet  it  bends  less 
to  system  than  any  other  branch  of  medicine;  and,  accordingly,  many 
of  the  different  sects  which  have  existed  from  time  to  time  have  been 
overthrown  by  this  great  test  of  their  validity  or  weakness.  In  the 


22 


GENERAL  CONSIDERATIONS. 


closet,  a consistent  scheme  may  be  formed  on  paper,  but  when  it 
comes  to  he  applied  clinically,  it  may  be  often  found  to  fail.  It  is 
obvious,  that,  cceteris  paribus^  Therapeutics  should  be  the  touchstone 
of  medical  skill : the  number  of  cures  ought  to  decide  the  qualifica- 
tions of  the  practitioner  ; but  it  is  so  extremely  difficult  — indeed 
impossible  — to  estimate  all  the  deranging  influences;  — so  many 
modifying  circumstances  are  perpetually  occurring,  that  we  cannot 
decide  that  any  two  cases  are  precisely  identical.  Hence,  we  can 
never  judge  of  the  comparative  success  of  different  practitioners,  on 
which  so  much  stress  is  placed  — and  placed  erroneously  — by  the 
public.  Owing  to  these  difficulties,  also,  we  have  such  a diversity 
of  sentiment  regarding  the  treatment  of  the  same  affection. 

Therapeutical  indications  vary  much,  however,  with  medical  the- 
ories. By  indication  is  meant  — the  end  to  be  had  in  view  in  the 
administration  of  remedies.  For  example,  in  a case  of  polysemia  or 
fulness  of  blood,  the  indication  is  obviously  to  diminish  the  amount 
of  the  circulating  fluid,  and  bleeding  is  the  remedy  usually  had  re- 
course to  for  fulfilling  it. 

Indications  of  treatment  have  necessarily  been  greatly  influenced  by 
the  views  of  the  dominant  medical  sect.  The  humorist  or  humoral 
pathologist,  who  looked  to  the  fluids  as  the  cause  of  all  maladies,  di- 
rected his  attention  to  the  removal  of  a fancied  acridity,  acidity,  or 
alkalescency  of  the  humours,  or  to  evacuate  them  after  they  had  ex- 
perienced a kind  of  maturation  or  preparation,  which  he  called 
concoction;  whilst  the  mechanical  philosopher  attended  to  the  per- 
meability, or  the  contrary,  of  vessels,  — the  effects  of  gravity,  and 
the  like ; and  his  indications  were  based  upon  his  ideas  on  those 
matters.  But  these  systems,  and  the  Therapeutics  founded  on  them, 
have  passed  away ; not,  however,  without  having  left  useful  memen- 
toes of  their  existence  ; for  it  is  obvious,  that  the  conditions  which 
they  invoked  cannot  be  wholly  disregarded  : the  evil  with  those 
pathologists  was,  that  they  assigned  to  them  too  prominent  a rank 
in  the  causation  of  disease,  and  that  they  attended  to  them  to  the 
exclusion  of  more  important  agencies. 

One  of  the  greatest  errors  in  the  investigation  of  disease,  and  its 
mode  of  management,  is  the  belief  which  long  existed,  and  still 
exists  with  the  mere  routine  practitioner,  that  it  is  only  necessary 
to  attend  to  symptoms  or  phenomena,  and  to  combat  the  most 
prominent  as  they  occur.  This  is  obviously  insufficient  without  in- 
quiring into  the  organ  that  is  suffering,  and  the  precise  nature  of 
the  existing  lesion.  The  same  symptom  may  be  present  in  diseases 
of  very  different  character  ; and  before  the  therapeutist  can  lay  down 
any  satisfactory  indications  of  treatment,  inquiry  must  be  made  into 
these  circumstances,  as  well  as  to  detect  whether  the  mischief  in  the 
organ  is  primary  or  secondary,  idiopathic  or  symptomatic;  — in 
other  words,  whether  the  morbid  mischief  has  commenced  in  the 
main  seat  of  the  disease,  or  has  begun  in  some  other  organ  or  tissue, 
and  extended  to  it  by  virtue  of  that  sympathy,  which  plays  so  impor- 


GENERAL  CONSIDERATIONS,  23 

tant  a part  in  every  physiological,  as  well  as  pathological  condition 
of  the  functions. 

The  insufficiency  of  attending  simply  to  the  more  prominent 
symptoms  is  readily  elucidated  by  a few  cases.  A feeling  of  de- 
bility is  a distressing  symptom  in  the  most  inflammatory,  as  well  as 
in  the  most  enfeebling,  disorder  ; yet  how  different  the  treatment ! 
Itching  of  the  glans  penis  is  symptomatic  of  stone  in  the  bladder. 
Itching  of  the  nose,  where  the  mucous  membrane  commingles  with 
the  skin,  occurs  in  irritation  of  the  lining  membrane  of  the  intesti- 
nal canal : in  hepatitis,  excruciating  pain  is  occasionally  felt  at  the 
top  of  the  shoulder  : painful  retraction  of  the  testis  occurs  in  nephri- 
tis ; and  intolerance  of  light  and  sound  are  distressing  symptoms 
of  cephalitis;  but  it  would  be  extremely  unphilosophical  to  attend 
solely  or  mainly  to  those  prominent  symptoms.  The  primary  seat 
of  irritation  must  be  inferred  from  them,  and  from  farther  atten- 
tive examination  ; and  it  is  not  until  the  physician  has  attained  a 
thorough  knowledge  of  the  seat  and  nature  of  the  disease,  that  a 
rational  basis  can  exist  for  his  curative  indications.  The  lesion  of 
the  affected  organ  must  be  appreciated.  This  is  the  point  of  de- 
parture for  an  enlightened  practice.  To  resolve  this  question  de- 
mands a careful  inquiry  into  etiology,  as  well  as  into  physiological 
pathology,  and  not  until  this  has  been  effected  can  the  practitioner 
properly  determine  on  the  indications  that  require  fulfilment,  and 
on  the  mode  of  fulfilling  them. 

The  fundamental  object,  in  every  indication,  is  to  put  a stop  to, 
or  mitigate  the  disorder  in  the  organic  actions,  and  to  remove  any 
alteration  that  may  have  supervened  in  the  tissues  consequent  on 
such  disorder.  If  inflammation,  for  example,  takes  place  in  any 
organ,  the  indication  is,  during  the  active  stage,  to  remove  the  par- 
ticular state  of  vessels,  which  constitutes  the  morbid  condition  ; 
and  if  suppuration,  induration,  or  any  other  of  the  terminations  of 
inflammation  should  ensue,  to  have  recourse  to  the  appropriate  reme- 
dies for  their  removal.  When  once  the  primary  organic  lesion  is 
removed,  the  symptoms  occasioned  by  it  will  disappear,  unless,  as 
in  the  case  of  the  terminations  of  inflammation,  irritations  — which 
have  become  independent  of  the  primary  affection  — should  persist, 
and  give  rise  to  a particular  train  of  symptoms.  The  attention  of 
the  therapeutist  has,  consequently,  to  be  directed,  in  the  first  in- 
stance, to  the  primary  lesion,  and  afterwards  to  the  secondary  or 
symptomatic. 

The  nature  of  the  disease,  then,  or  the  precise  species  of  vital 
modification  of  tissue,  that  gives  occasion  to  the  morbid  pheno- 
mena, must  be  the  base  of  every  therapeutical  indication  ; and 
although  the  symptoms  or  manifestations  may  differ  in  the  different 
ages  and  sexes,  and  according  to  the  strength,  &c.,  of  the  patient,  the 
indications  will  be  essentially  the  same  ; and  the  treatment  will  rest 
on  the  same  general  principles,  requiring  modifications  according 
to  circumstances,  but  ^hese  constitute  secondary  considerations. 


24 


GENERAL  CONSIDERATIONS. 


Particular  causes,  seat,  organisation,  &c.,  of  the  disease  may  sug- 
gest modifications  of  treatment,  — may  induce  us  to  select  one 
drug  or  combination,  or  one  form  of  administration  rather  than 
another,  — but  the  great  indications  will  usually  be  identical,  and 
the  lesion,  in  all  cases,  must  be  regarded  as  virtually  the  same. 
In  inflammation,  for  example,  the  general  rule  must  be  laid  down, 
that  the  ordinary  antiphlogistic  remedies  are  indicated  ; and  this, 
whatever  may  be  the  seat  of  the  inflammation,  or  the  strength, 
age,  habit,  &c.,  of  the  patient ; still,  many  modifications  in  the 
treatment  may  be  demanded  according  to  these  various  circum- 
stances. It  has  been  already  remarked,  that  the  ordinary  antiphlo- 
gistic remedies  are  required,  as  a general  rule,  in  inflammation.  This 
morbid  condition  is,  however,  at  times,  extremely  difficult  of  detec- 
tion, in  consequence  of  circumstances  attending  it,  which  are  inap- 
preciable except  by  experiment,  and  very  frequently  afterwards.  To 
explain  this,  the  case  of  a blood-shot  eye  may  be  taken,  — a state  of 
the  conjunctiva  in  which  red  blood  is  forced  into  vessels  that  pre- 
viously conveyed  only  white  blood.  A grain  of  sand,  or  some  ex- 
traneous substance,  has  excited  irritation  in  the  conjunctiva,  and  the 
consequence  has  been  an  afflux  of  fluids  to  the  irritated  part.  The 
smaller  arteries  have  taken  upon  themselves  augmented  action  ; blood 
has  been  sent  in  undue  quantity  into  the  extreme  vessels,  which 
have  become  over-distended ; so  that,  in  the  case  assumed,  there 
is  an  over-distended  state  of  extreme  vessel,  and  an  over-excited 
state  of  the  artery  communicating  with  it.  This  is  a familiar  and 
striking  example  : it  does  not,  however,  apply  only  to  the  blood- 
shot eye,  but  to  every  case  of  inflammation.  In  this  state  of  parts, 
it  is  manifest,  that  so  long  as  the  extreme  vessel  remains  over- 
dilated, there  will  be  remora  of  blood  in  it  to  a greater  or  less 
extent ; the  circulation  cannot  proceed  as  uninterruptedly  through 
it  as  through  a capillary  vessel,  whose  coats  are  in  a condition 
of  healthy  tone  : owing  to  this  circumstance,  excitement  is  kept 
up  in  the  vessels  immediately  communicating  with  the  over-distended 
extreme  vessels,  which  excitement  continues  so  long  as  the  over- 
distension persists,  and,  in  many  cases,  the  irritation  is  extended  from 
the  parts  first  affected  to  the  general  sanguiferous  system,  until  ulti- 
mately the  heart  and  arteries  are  in  a state  of  excitation  and  turmoil. 

Now,  a great  difficulty  in  investigating  the  pathology  of  inflamma- 
tion consists  in  our  not  always  being  able  to  discover  whether  this 
atonic  condition  of  the  extreme  vessel,  induced  by  over-distention, 
or  the  over-excited  state  of  the  vessel  communicating  with  it,  is  the 
condition  which  more  especially  requires  attention  : hence  the  diffi- 
culty of  saying,  in  all  cases,  whether  astringents  or  slight  stimulants, 
or  the  opposite  plan  of  treatment  — the  soothing — ought  to  be  had 
recourse  to.  Every  practitioner  meets  with  this  difficulty,  and  hence, 
in  cases  of  external  inflammation,  he  is  often  compelled  to  resort 
empirically  to  one  set  of  applications,  and  if  it  should  not  succeed,  to 
the  other.  * 


GENERAL  CONSIDERATIONS. 


25 


Tn  certain  textures  of  the  body  the  predominance  of  over-distention 
of  extreme  vessel  appears  to  exist,  when  they  labour  under  inflamma- 
tion, more  commonly  than  in  others.  This  seems  to  be  the  case  with 
inflammation  of  the  skin  and  mucous  membranes,  which  belongs  to 
the  variety  of  erysipelatous  inflammation  ; whilst  that  of  the  cellular 
and  serous  membranes  is  of  a more  active  cast,  and  may  be  regarded 
as  appertaining  to  the  phlegmonous  variety.  Accordingly,  in  erysi- 
pelas, and  in  some  of  the  inflammations  of  mucous  membranes,  reme- 
dies are  occasionally  had  recourse  to,  which  can  rarely  be  employed 
in  the  other  variety,  — that  is,  in  the  inflammation  of  the  cellular 
membrane,  and  of  the  serous  membranes ; for  the  latter  obviously 
cannot  be  reached  so  that  applications  may  be  made  immediately  to 
them.  Hence,  in  some  varieties  of  burn,  or  erysipelatous  inflamma- 
tion of  the  skin,  stimulating  applications  are  found  of  service  ; whilst 
in  others,  where  the  excitement  in  the  communicating  vessels  is 
powerful,  antiphlogistic  agents  are  demanded.  Cases  of  varied  in- 
flammation of  the  eye  have  been  given,  in  which  decided  advantage 
was  produced  by  dropping  the  essential  oil  of  lemons  upon  the  in- 
flamed surface  ; and,  in  most  cases  of  chronic  inflammation,  the  ap- 
plication of  gentle  excitants  is  found  to  be  beneficial ; accordingly, 
after  gonorrhoea,  for  example,  which  is  an  inflammation  of  the  lining 
membrane  of  the  urethra,  has  continued  for  a long  period,  we  attempt 
to  arrest  the  discharge  by  astringent  excitants,  and  if  these  are  in- 
sufficient, the  bougie  is  sometimes  passed,  to  excite,  by  contact,  the 
vessels  to  their  healthy  tone  ; and  in  this  manner  the  gleet  is  often 
got  rid  of,  after  it  had  resisted  the  continued  use  of  ordinary  antiphlo- 
gistics.  In  all  these  cases  — as  in  every  other  — rational  Therapeu- 
tics must  be  founded  on  rigid  physiologico-pathological  deductions. 

It  is  important  in  every  morbid  condition  to  inquire  into  the  cause, 
that  may  have  produced,  or  is  producing,  the  phenomena.  That  this 
must  always  be  removed,  when  practicable,  is  a self-evident  indica- 
tion. The  maxim,  “ Tolle  causam  cessat  pectus, although  often 
true,  is  not  always  so.  If  a thorn  be  run  into  the  flesh,  irritation 
will  exist  so  long  as  the  thorn  remains  there  ; and  if  it  be  removed, 
the  recuperative  powers  of  the  part  will  speedily  repair  the  injury 
that  has  been  inflicted.  In  like  manner,  if  a decayed  or  loose  tooth 
be  exciting  repeated  gum-boils,  the  obvious  remedy  is  to  remove  the 
tooth  ; yet  in  the  large  mass  of  cases,  although  the  cause,  which  im- 
mediately produced  the  disease,  is  taken  away,  the  complaint  con- 
tinues. A man,  from  a night’s  sojourn  in  a malarious  district,  may 
receive  a sufficient  dose  of  the  exciting  cause  of  intermittent  fever  to 
induce  the  disease,  and  although  he  may  be  removed  from  the  un- 
healthy locality,  the  fever  will  persist  after  his  change  of  residence. 
It  may  be  said  that,  in  this  case,  the  malaria  may  still  be  present  in 
the  sysfem,  and  this  is  possible ; but  it  is  more  probable  — more 
consistent  with  analogy  — that  a morbid  influence  is  exerted  on  the 
nervous  system  from  such  exposure,  and  that  the  effects  go  on,  not- 
withstanding the  abstraction  of  the  morbific  cause  ; in  the  same  man- 
VOL.  I, — 3 


26 


CJENERAL  CONSIDERATIONS. 


ner  as  disease,  produced  by  local  irregularity  of  action  in  the  capil- 
lary system,  owing  to  exposure  to  cold  and  moisture,  may  persist, 
notwithstanding  the  removal  of  the  cause  has  been  complete,  'hhere 
is  probably,  at  all  times,  a greater  predisposition  in  the  body  to  assume 
a diseased  action  in  some  particular  organ  or  tissue  than  in  another ; 
so  that  if  irregularity  of  capillary  action  be  induced  in  any  external 
part  of  the  organism,  the  mischief  may  not  supervene  in  the  part 
where  such  irregularity  exists,  but  in  the  organ  especially  predisposed 
to  assume  a morbid  action,  through  the  extensive  sympathy  which 
exists  between  every  part  of  the  capillary  system.  Owing  to  this  cir- 
cumstance, the  difficulty  in  discovering  the  precise  cause  of  a disease 
is  often  extreme.  Fortunately,  the  discovery  is  not  always  a matter  of 
moment,  inasmuch  as  the  disease  usually  continues  independently  of 
the  cause  ; and  it  is  the  disease  — the  modification  in  the  structure  or 
functions  that  constitutes  the  pathological  condition  — which  we  have 
to  combat.  In  all  cases,  the  patient  is  anxious  to  find  out,  and  to 
suggest,  a cause  ; and  the  suggestions  are  frequently  of  the  most  un- 
philosophical  character  ; but  although  the  practitioner  feels  this,  it  is 
unnecessary  that  he  should  show  it. 

Allusion  has  been  made  to  the  influence  exerted  from  time  to  time 
by  dominant  medical  sects  on  Therapeutics.  Such  reminiscences  are 
often  well  adapted  for  diminishing  our  pride  in  what  are  regarded  as 
modern  improvements,  and  for  inducing  us  to  form  a more  exalted 
opinion  of  our  brethren  in  ancient  periods.  The  credit  of  original 
conception  has,  indeed,  been  often  awarded  for  observations  and 
opinions,  which  had  been  inculcated  ages  before,  escaped  notice, 
and  been  subsequently  re-propounded  ; the  ancient  and  the  modern 
being  equally  entitled,  however,  to  the  credit  of  originators. 

Prior  to  the  age  of  Hippocrates,  no  science  of  medicine  existed. 
The  priests  obtained  from  the  votive  tablets,  hung  up  in  the  temples, 
records  of  cases  and  of  reputed  cures  by  remedies  prescribed  empiri- 
cally ; but  we  have  no  evidence,  that  any  attention  had  been  paid  to 
the  relation  between  the  symptoms  and  causes  and  the  morbid  con- 
dition. Pathology,  in  other  words,  was  unknown.  All  medicine 
was  in  the  hands  of  the  priests,  and  it  was  associated  with  numerous 
superstitions,  and  exercised  too  often  as  a means  of  deluding  and 
astounding  the  people,  and  of  adding  to  the  power  of  the  priesthood. 
Hippocrates  first  endeavoured  to  establish  the  relation  between  the 
various  facts  observed  by  him  and  his  predecessors,  and  to  deduce 
theory  or  general  principles  therefrom  : hence,  he  has  been  com- 
monly regarded  as  the  father  of  the  rational  or  dogmatical  system  of 
medicine,  as  it  was  then  called.  Others  refer  this  sect  to  Draco  and 
Thessalus,  sons  of  Hippocrates,  and  to  Polybus,  his  son-in-law ; but 
their  illustrious  ancestor  is  doubtless  entitled  to  the  credit. 

“ Although,”  as  a recent  writer  has  remarked,  we  can  have  no 
hesitation  in  pronouncing  this  to  be  the  correct  and  legitimate  method 
of  pursuing  the  study  of  medicine,  yet  it  must  be  acknowledged  at 
the  same  time,  that  it  is  a method,  which,  if  not  carefully  watched. 


GENERAL  CONSIDERATIONS. 


27 


and  strictly  guarded  by  prudence  and  sagacity,  is  exposed  to  the 
greatest  danger  of  being  corrupted  by  ignorance  and  presumption. 
Hence,  we  may  easily  conceive,  that  it  would  be  liable  to  fall  into 
the  grossest  errors,  and  to  lie  open  to  the  most  serious  imputations, 
and  that  a fair  plea  would  always  be  found  for  exclaiming  against 
the  introduction  of  what  is  termed  theory  into  the  practice  of  medi- 
cine.” ' Thus  it  was  of  old : the  philosophical  principles  of  Plato 
and  of  Aristotle  were  amalgamated  into  the  systems  of  medicine,  — 
nay,  formed  their  very  bases ; experience  and  observation  were  re- 
jected, and  useless  subtleties,  which  to  us  at  the  present  day  are  un- 
intelligible, occupied  the  attention  of  the  physician. 

The  absurdities,  thus  engendered,  gave  rise,  in  no  great  length  of 
time  — as  might  have  been  expected  — to  a complete  revolution,  and 
to  the  formation  of  a new  sect,  utterly  opposed  to  the  dogmatists,  of 
which  Serapion,  of  Alexandria,  was  the  founder.  This  occurred 
shortly  after  the  establishment  of  the  Alexandrian  school.  Serapion 
had  many  followers  among  the  ancients,  who  were  distinguished  for 
their  abilities,  and  were  termed  Empirics.  Two  rival  sects  then 
usurped  the  domain  of  medicine — the  Dogmatists  or  Rationalists., 
and  the  Empirics. 

As  the  Dogmatists  rejected  all  experience  and  observation,  so  the 
Empirics  held,  that  the  philosophy  of  the  time  was  foreign  to  the  art 
of  medicine,  and  that  all  sound  experience  must  be  the  result  of  ob- 
servation alone.  It  was  deemed  unnecessary  to  inquire  into  the 
etiology  or  causes  of  disease,  except  as  regarded  such  as  were  evi- 
dent; anatomy  was  discarded  ; and  the  dissection  of  bodies  with  the 
view  of  detecting  the  nature  of  disease  was  contemned  : — in  short, 
nothing  but  the  evidence  of  the  senses  was  admitted  as  the  basis  of 
medical  knowledge. 

To  the  latter  of  these  sects,  the  Empirics,  which  long  continued  to 
include  all  the  members  of  the  profession,  belonged  the  learned  and 
classic  Celsus.  He  manifestly,  at  least,  favors  the  views  which  the 
Empirics  adopted.  Still,  his  remarks,  after  a brief  consideration  of 
the  doctrines  of  the  two  sects,  are  such  as  every  enlightened  physi- 
cian of  the  present  day  would  be  willing  to  endorse,  — that  the  true 
rule  of  practice  must  be  deduced  from  a proper  combination  of  reason 
and  experience  ; — that  without  experience  all  preconceived  theory 
would  be  vain  and  useless,  and  that  by  simple  experience,  without 
any  attempt  at  generalization,  we  should  frequently  fall  into  gross 
errors,  and  be  unable  to  profit  even  from  the  best  experience.  It  is 
difficult,  indeed,  to  imagine  how  either  sect  could  be  able  to  confine 
itself  rigidly  within  the  rules  of  its  own  doctrines.  As  at  the  present 
day,  there  must  always  have  been  dogmatists,  who  could  not  consent 
to  reject  all  observation,  and  empirics  who  felt  constrained  to  theorise. 

The  Dogmatists  and  Empirics  were  ancient  sects;  but  in  all  ages, 
from  the  periods  to  which  allusion  has  been  made  downwards,  there 
have  been  physicians,  who  pretended  to  be  guided  solely  by  a rigid 
attention  to  observation,  and  others  who  indulged  in  the  wild- 


28 


GENERAL  CONSIDERATIONS. 


est  and  most  visionary  hypotheses,  despising  all  observation  ; yet,  at 
the  ])resent  day,  few  would  admit,  that  they  reject  either  reasoning 
or  observation,  and  it  may  be  safely  affirmed  that  those  few  are  unfit 
for  the  practical  exercise  of  their  elevated  calling. 

The  closest  approximation  to  the  ancient  sect  of  Empirics  is  the 
modern  French  School  of  Observation.  “ This  school,”  says  a re- 
cent American  writer,  and  able  supporter.  Dr.  Bartlett,  “ is  charac- 
terised by  its  strict  adherence  to  the  study  and  analysis  of  morbid 
phenomena  and  their  relationships  ; by  the  accuracy,  the  positiveness 
and  the  minute  detail,  which  it  has  carried  into  this  study  and  ana- 
lysis ; and  by  its  rejection,  as  an  essential  or  legitimate  element  of 
science,  of  all  h priori  reasoning  or  speculation.  The  spirit  which 
animates,  and  guides,  and  moves  it,  is  expressed  in  the  saying  of 
Rousseau,  ‘ that  all  science  is  in  the  facts  or  phenomena  of  nature 
and  their  relationships,  and  not  in  the  mind  of  man,  which  discovers 
and  interprets  them.’  It  is  the  true  protestant  school  of  medicine. 
It  either  rejects  as  apocryphal,  or  holds  as  of  no  binding  authority, 
all  the  traditions  of  the  fathers,  — unless  they  are  sustained  and  sanc- 
tioned by  its  own  experience.  It  appeals  in  all  things  directly  to 
nature,  and  it  asks  — not  what  may  he  ? or  what  ought  to  he  ? but 
what?5?  — not  how  things  are?  or  they  are  ? but  again 
they  are  ? Holding  that  medical,  as  well  as  all  other  science,  should 
have  but  one  aim  and  object,  to  ascertain  the  actual  constitution  of 
things,  — it  professes  an  entire  scientific  indifference  as  to  the  issue, 
and  result  of  its  researches,  provided  only  that  this  issue  and  result 
approach,  in  the  nearest  possible  degree,  to  the  absolute  truth  ; and 
it  adopts  and  pursues  what  it  conceives  to  be  the  only  method  and 
means  of  accomplishing  this  end.” 

Yet  schools  of  this  kind  have  existed  in  all  times,  and,  from  the 
first  moment  that  a medicinal  agent  was  prescribed  to  the  present 
day,  physicians  have  professed  to  be  observers  and  to  have  but 
one  aim  and  object,  to  ascertain  the  actual  constitution  of  things.” 
Of  the  myriads  of  remedies  brought  forward,  and  too  often  with 
exaggerated  pretensions,  we  should  scarcely  be  justified  in  affirming, 
that  a single  one  was  extolled  without  the  propounder  having  satis- 
fied himself  that  such  was  the  actual  constitution  of  things ;”  and 
admitting,  that  a large  mass  of  the  recorded  “ facts,”  as  they  have 
been  termed,  have  been  badly  observed  ; it  must  be  equally  admitted, 
that  they  were  accredited  results  of  positive  observation,  and,  there- 
fore, not  to  be  disregarded  on  light  grounds  by  a school  w-hich  pro- 
fesses to  be  a school  of  observation,  par  excellence^ — “ the  true  pro- 
testant school  of  medicine,  which  either  rejects  as  apocryphal  or  holds 
as  of  no  binding  authority,  all  the  traditions  of  the  fathers,  unless 
they  are  sustained  by  its  own  experience.” 

The  distinguished  head  of  this  modern  school  — if  it  may  be  so 
termed  — the  indefatigable  and  philosophical  Louis  would  scarcely, 
however,  arrogate  so  much  to  himself  and  his  system.  To  borrow 
his  own  language  — “ It  has  been  acknowledged,  from  time  imme- 


GENERAL  CONSIDERATIONS. 


29 


morial,  that  medicine  is  a science  of  observation  ; nay,  it  has  been 
said,  that  it  consisted  solely  in  observation,  — that  is  to  say,  it  has 
been  allowed,  that  nothing  can  be  done  in  medicine  save  by  means 
of  well  observed  facts:”  — and  the  causes  to  which  he  attributes  the 
imperfection  of  medical  science  are,  “ on  the  one  hand,  imperfect 
observation,  and  on  the  other,  the  habit  of  making  analyses,  which 
are  incomplete  or  dependent  upon  facts  entrusted  to  the  memory.” 

The  great,  the  crowning  merit  of  M.  Louis  has  consisted  in  urging, 
and  carrying  into  effect,  with  a tact,  industry  and  talent  worthy  of  all 
commendation,  and  for  which  he  deserves  the  gratitude  of  the  pro- 
fession, an  improved  system  of  analysis  by  the  employment  of 
numbers  or  the  calculation  of  probabilities  applied  to  medicine.  To 
this  numerical  method,  the  generic  name  Statistique  Medicals  has 
been  applied  by  certain  of  the  French  writers.  Originally,  the  word 
statistics  meant  the  science  of  states,  from  the  German  staat ; but  by 
an  extension  of  signification  by  no  means  uncommon,  a term,  which 
was  originally  applied  only  to  states,  came  to  be  extended  so  as  to 
comprise,  as  at  the  present  day,  in  its  signification  the  “ numeral  or 
numerical  method,”  or  numbers  employed  for  the  elucidation  of  any 
of  the  sciences  of  observation  ; — and  the  term  “ medical  statistics'^'* 
is  now  as  well  understood  as  medical  jurisprudence.'*'* 

The  employment  of  numbers  as  a means  of  comparison  is  by  no 
means  new;  yet,  in  consequence  of  the  term  “statistics”  being  of 
modern  origin,  it  has  been  presumed  by  many  that  numerical  methods 
were  unknown  until  very  recent  periods.  They  have,  however,  long 
been  used  in  other  branches  of  science,  and  their  non-employment  in 
medicine,  until  of  late,  only  shows,  that  our  science  has  profited  but 
little  by  the  example  of  the  more  perfect  sciences. 

Impressed  with  the  imperfect  rnethods  of  observation  that  had  pre- 
viously existed,  and  were  still  existing,  M.  Louis  proposed  to  intro- 
duce, as  far  as  possible,  the  same  mode  of  exact  estimation  as  had 
been  practised  in  chemistry,  for  example.  “ Doubtless,”  he  observes, 
“this  department  of  learning  had  many  learned  men  among  its  vota- 
ries previous  to  the  last  forty  years;  nevertheless,  it  is  only  within 
this  last  period  that  chemistry  has  made  rapid  progress.  What  means 
has  it  employed  of  late,  which  were  not  used  before  ? It  has  de- 
manded exactness,  it  has  weighed  and  counted  always  when  it  was 
able  to  do  so.  It  has  taken  rigid  notice  of  every  thing  which  had  any 
bearing  upon  a question.  It  has  substituted  a strict  analysis  for  an 
imperfect  and  careless  one.  Its  methods  have  been  daily  more  and 
more  precise,  and  its  progress  is  rapid  and  constant.  The  same 
cause,  which  kept  chemistry  so  long  in  its  infancy  — the  want  of 
rigid  method  — has  weighed  upon  the  destiny  of  medicine,  and  pre- 
vented its  growth.” 

Much  has  been  written,  of  late,  against  the  practicability  of  em- 
ploying numbers  or  of  counting  in  medicine,  notwithstanding  the 
valuable  and  precise  information  that  has  been  afforded  for  ages — 
even  from  the  time  of  Ulpian — in  regard  to  the  laws  that  govern  the 
3^ 


30 


gp:neral  considerations. 


movement  of  the  population,  the  calculation  of  probabilities  as  to  the 
average  duration  of  life,  and  afterwards  as  a guide  to  the  insurance 
of  lives,  &c.,  &c.  What  are  these  but  the  application  of  numbers  to 
elucidate  the  science  of  life  ! The  nearest  approximation  to  the  truth 
in  regard  to  facts  or  observed  phenomena  must  obviously  be  deduced 
in  this  manner.  It  is  the  only  accurate  mode  in  which  averages  can 
be  taken.  Every  practitioner,  in  all  periods  of  history,  has  endea- 
vored to  carry  in  his  recollection  the  precise  difference  which  he 
notices  from  day  to  day  in  the  condition  of  his  patient ; but  this 
course  must  be  far  inferior  to  the  record,  which  he  daily  makes  ap- 
proximately by  numbers,  from  which  he  can  deduce  his  averages. 
‘‘  Averages,”  as  an  able  writer.  Dr.  Holland,  has  observed,  “ may, 
in  some  sort,  be  termed  the  mathematics  of  medical  science.  It  is 
obvious  indeed,  that  the  value  of  inferences  thus  obtained  depends 
on  the  exact  estimate  of  what  are  the  same  facts  ^ — what  merely  con- 
nected by  resemblance  or  partial  analogy.  Pathological  results,  es- 
sentially different,  may  be  classed  together  by  inexact  observers,  or  by 
separate  observers  under  different  views.  These,  however,  are 
errors  incident  to  every  human  pursuit,  and  best  corrected  by  numerous 
and  repeated  averages.  The  principle  in  question  is  indeed  singu- 
larly effectual  in  obviating  the  difficulties  of  evidence  already  noticed, 
and  the  success  with  which  it  has  been  employed  of  late  by  many 
eminent  observers  affords  assurance  of  the  results  that  may  hereafter 
be  expected  from  this  source.  Through  medical  statistics  lies  the  most 
secure  path  into  the  philosoply  of  medicine.” 

It  will  not  be  contested  by  any  one,  that  facts  must  be  accurately 
observed  before  they  can  be  made  the  basis  of  any  calculation.  It 
is  clear,  too,  that  averages  deduced  from  a small  number  of  observa- 
tions may  lead  us  into  error.  Tables  of  insurance  of  lives,  calcu- 
lated from  the  observation  of  one  or  two  years,  would  certainly  be 
fallacious  ; but  all  experience  teaches  that  those  drawn  from  the  cal- 
culation of  a long  series  of  years  lead  to  most  satisfactory  results. 

The  numerical  method  is,  however,  more  applicable  to  phenomena 
presented  by  the  healthy  or  diseased  economy  than  to  therapeutics 
or  the  treatment  of  disease,  which,  after  all,  is  the  end  and  aim  of 
all  our  studies.  It  is,  confessedly,  the  most  difficult  of  the  depart- 
ments of  medical  science,  because  in  it  is  concentred,  or  ought  to  be 
concentred,  a knowledge  of  every  other;  and,,  moreover,  it  requires 
— contrary  to  what  has  been  affirmed  by  the  Empirics,  not  simply 
observation,  but  the  constant  use  of  reason,  to  rectify  the  erroneous 
impressions,  which  imperfect  observation, — imperfect,  that  is  without 
it,  — so  often  occasions.  A glance  at  the  history  of  medicine  exhibits, 
that  the  science  has  suffered  more  from  faulty  observation  than  from 
faulty  theories.  It  will  generally,  indeed,  be  found,  that  theories 
have  been  based  upon  fancied  observation. 

‘‘  From  the  manner,”  — says  Dr.  John  Gregory,  — ‘Gn  which  empi- 
rics in  all  ages,  have  conducted  themselves,  it  is  not  surprising,  that  their 
writings  have  tended  so  little  to  the  advancement  of  the  art ; and  that, 


GENERAL  CONSIDERATIONS. 


31 


on  the  contrary,  they  have  had  the  greatest  share  in  encumbering  it 
with  the  many  falsehoods  under  which  it  has  labored  so  long,  par- 
ticularly that  important  branch  which  relates  to  the  effects  of  medi- 
cines. It  has  been  pretended,  that  such  empirical  books  as  I have 
alluded  to  maybe  useful  to  those  who  are  not  bred  to  the  profession, 
and  wdio  wish  only  to  acquire  some  knowledge  of  the  practical  part 
of  physic.  But  this  is  so  far  from  being  the  case,  that  these  are  the 
only  people  to  whom  such  books  are  dangerous.  A physician  of 
real  knowledge  and  practice  may  draw  instruction,  or  catch  hints, 
from  facts  related  in  an  imperfect  manner,  which  will  either  be  use- 
less, or  tend  to  mislead  others  who  have  not  these  advantages.  To 
such,  all  the  circumstances  relating  to  the  exhibition  of  a remedy  can 
never  be  too  distinctly  specified.” 

On  the  occasion  of  almost  every  introductory  lecture  to  his  class, 
the  author  has  dwelt  upon  the  heresy  of  trusting  implicitly  to  simple 
observation,  and  of  merely  registering  the  prominent  result ; and  he 
has  strongly  urged  a wise  combination  of  dogmatism  or  rationalism 
with  empiricism — to  employ  the  language  of  the  ancients — before  we 
feel  ourselves  justified  in  recording  our  facts  as  guides  for  future  ac- 
tion. That  a patient  has  died,  or  recovered,  may  be  self-evident, 
and  the  fact  may  furnish  a datum  for  the  calculations  of  the  medical 
statistician  ; but  a knowledge  of  the  precise  agency  of  the  different 
remedies  employed  in  any  case  may  demand  an  intimate  acquaint- 
ance with  the  physiological,  pathological  and  therapeutical  bearings 
of  the  subject,  and  withal  no  little  power  of  discrimination  on  the 
part  of  the  practitioner..  A case  or  two,  placed  upon  record  by  dis- 
tinguished members  of  the  profession,  will  illustrate  more  strikingly, 
by  example,  the  essential  difference  between  the  information  which 
simple  observation  might  suggest;  and  that  which  would  flow  from 
observation  conjoined  with  rational  inquiry. 

In  the  next  chapter  the  author  has  alluded  to  a well-known  case, 
cited  by  Dr.  Paris,  in  his  life  of  Davy,  in  which  Dr.  Beddoes  and 
Davy  were  about  to  try  the  effects  of  the  inhalation  of  nitrous  oxide 
gas  for  the  removal  of  palsy,  but  having  inserted  a thermometer 
in  the  man’s  mouth,  and  the  patient  believing  that  the  thermometer 
was  the  curative  agent,  and  saying  that  he  felt  something  better,  it 
was  determined  to  administer  no  laughing  gas,”  but  to  repeat  the 
application  of  the  thermometer,  and  to  trust  to  this  alone,  which  was 
accordingly  done  daily  for  a fortnight,  and  at  the  end  of  this  time  he 
was  dismissed  cured. 

Now,  in  this  case,  mere  empirical  observation  wmuld  lead  to  the 
record,  that  the  thermometer  under  the  tongue  cured  a case  of  palsy. 
But  the  rational  therapeutist  is  not  satisfied  with  a knowledge  of  the 
fact,  that  the  paralysis  disappeared  after  the  use  of  the  thermometer. 
He  does  not  record,  that  the  thermometer  is  “ good” — a common 
expression  — in  palsy.  He  ponders  on  the  mode  in  which  the  result 
was  probably  induced,  and  he  is  not  long  in  discovering,  that  the 
instrument,  in  such  case,  must  be  classed  with  those  agents,  that 


32 


GENERAL  CONSIDERATIONS. 


produce  their  effects  by  the  new  impressions  which  they  make  on  the 
nervous  system  through  the  external  senses. 

Another  familiar  illustration  may  be  given.  It  is  related,  for  an 
analogous  purpose,  by  Dr.  Moore,  the  distinguished  author  of  Zeluce 
The  story  is  the  prototype  of  many  similar  anecdotes  that  have  been 
told  since,  and  it  is  not  an  overdrawn  picture  of  the  mode  in  which 
experience  must  have  been  registered  in  days  of  yore  ; nor  is  it 
without  its  application  at  the  present  day,  especially  to  those  who, 
without  the  observing  and  logical  mind  of  Louis,  consider  them- 
selves followers  of  his  system,  and  rigid  recorders  of  observed  re- 
sults— “sustained  and  sanctioned  by  their  own  experience” — in 
their  view,  the  only  test  of  truth. 

“ A French  Student  of  Medicine,”  says  Dr.  Moore,  “ lodged  in 
the  same  house  in  London  with  a man  in  fever.  This  poor  man 
was  continually  teazed  by  the  nurse  to  drink,  though  he  nauseated 
the  insipid  liquids  that  were  presented  to  him.  At  last,  when  she 
was  more  importunate  than  usual,  he  whispered  in  her  ear:  — ‘ for 
God’s  sake  bring  me  a salt  herring,  and  I will  drink  as  much  as  you 
please!’  The  woman  indulged  him  in  his  request,  he  devoured  the 
herring,  drank  plentifully,  underwent  a copious  perspiration,  and 
recovered.  The  French  student  inserted  this  aphorism  in  his  jour- 
nal: — ‘A  salt  herring  cures  an  Englishman  in  his  fever.’  On  his 
return  to  France,  he  prescribed  the  same  remedy  to  the  first  patient 
in  fever  to  whom  he  was  called.  The  patient  died,  on  which  the 
student  inserted  in  his  journal  the  following  caveat: — ‘ N.B. — Though 
a salt  herring  cures  an  Englishman,  it  kills  a Frenchman.’  ” 

And  these  were  good  honest  examples  of  simple  observation,  of 
pure  empiricism  ! 

A just  appreciation  of  the  effects  of  therapeutical  agents,  and  the 
determination  of  their  action,  whatever  that  may  be,  are  properly 
regarded  by  M.  Louis  as  the  most  important,  and,  at  the  same  time, 
the  most  difficult  parts  of  the  method  of  observing.  So  many  dis- 
turbing influences  have,  indeed,  to  be  borne  in  mind  in  the  estimate, 
that  the  inquiry  has  appeared  to  some  to  transcend  the  powers  of  the 
human  mind.  “ We  must  compare  together,” — says  that  distin- 
guished observer — “ a great  number  of  cases  of  the  same  disease  of 
equal  severity,  some  relating  to  subjects  in  whom  the  disease  was 
left  to  itself ; others  of  individuals  to  whom  certain  medicines  were 
given.  After  doing  this,  we  must  study  the  action  of  the  same  thera- 
peutical agent  on  those  in  whom  the  disease  was  severe,  and  on 
those  in  whom  it  was  slight — on  those  in  whom  the  remedy  has  been 
used  in  large  or  small  doses,  at  a period  near  to,  or  remote  from,  the 
commencement  of  the  disease.  This  last  circumstance  is  very  im- 
portant. So  likewise  we  must  mention,  whether  the  medicine  is 
used  alone,  or  in  conjunction  with  other  remedies.  But  not  only 
does  this  method  require  much  labour,  it  also  supposes  a consider- 
able series  of  facts,  the  connexion  of  which  is  difficult,  especially 
when  treating  severe  affections,  in  which  we  are  accustomed  to  fre- 


GENERAL  CONSIDERATIONS. 


33 


quently  make  new  attempts,  and  which  will  not  allow  of  our  remain- 
ing a mere  spectator  of  the  progress  of  the  disease.  For  it  must  be 
evident,  that  we  do  not  seek  to  know,  by  approximation,  what  reme- 
dies have  appeared  to  be  more  or  less  successful,  but  to  demonstrate 
in  a rigorous  manner,  that  a certain  remedy  or  certain  method  is 
useful  or  hurtful,  and  in  different  degrees,  according  to  the  manner 
in  which  we  employ  it.” 

The  necessity  for  such  repeated  observations  to  enable  us  to  make 
any  accurate  estimate  of  therapeutical  agencies  has  been  felt  and 
appreciated  by  every  able  medical  statistician.  But  it  is  not  easy  to 
multiply  observations  to  the  requisite  extent.  Even  M.  Louis  him- 
self has  been  censured  by  M.  Gavarret  for  having  ventured  to  pro- 
nounce as  to  the  limited  efficacy  of  blood-letting  in  pneumonia, 
erysipelas  of  the  face,  and  cynanche  tonsillaris,  on  the  strength  of  one 
hundred  cases  of  the  first  disease,  forty-four  of  the  second,  and 
twenty-three  of  the  third  ; and  the  latter  gentleman  lays  it  down  as 
an  undoubted  principle,  that  every  statistical  inquiry,  in  order  to 
furnish  admissible  indications,  ought  to  consist  of  many  hundreds  of 
observations.  Were  this  indispensable,  it  would  be  obviously  im- 
possible to  arrive  at  any  satisfactory  knowledge  in  regard  to  the 
effect  of  remedies ; for,  amidst  the  numerous  shades  of  difference  in 
the  manifestations  of  disease,  it  would  be  difficult  — if  not  impracti- 
cable — from  hundreds  of  cases  of  the  same  malady  to  find  a dozen 
that  are  circumstanced  exactly  alike,  and  that  would  consequently 
admit  of  unquestioned  therapeutical  deductions. 

The  marked  difference  between  the  amount  of  information  de- 
rivable from  the  system  of  observation  inculcated  by  the  school  of 
Louis,  when  applied  to  the  manifestations  and  to  the  treatment  of 
disease,  has  impressed  all  observers.  It  is  signally  exhibited  in  the 
valuable  works  which  have  emanated  from  that  school,  even  in  those 
of  the  great  master  himself.  Whilst  his  Researches  on  Phthisis” 
are  replete  with  accurate  information  on  the  pathological  anatomy, 
semeiology,  diagnosis,  termination,  prognosis  and  etiology  of  the 
disease,  — on  every  thing  that  admits  of  being  counted, — the  treat- 
ment is  meager  and  unsatisfactory,  consisting  of  little  more  than  a 
catalogue  of  curative  procedures.  Not  a particle  of  therapeutical 
information  is  added  to  what  was  already  possessed  on  the  subject. 

These  remarks  apply  equally  to  the  second  edition,  a translation 
of  which  has  been  issued  by  the  Sydenham  Society,  of  London  ; 
and  they  are  perhaps  even  more  applicable  to  a treatise  on  typhoid 
fever,  which  has  been  published  in  this  country  by  one  of  the  disci- 
ples of  Louis. 

This  essential  difference  between  the  applicability  of  the  numerical 
method  to  diagnosis  and  to  therapeutics  is,  in  a great  measure,  the 
cause  ofthe  former  being  often  attended  to,  to  the  exclusion  of  the  latter, 
and  of  the  separation  of  what  has  been  called,  by  some,  the  science 
from  the  art  of  medicine.  As  a matter  of  scientific  research  it  might 
be  interesting  to  understand  disease,  even  if  we  did  not  attempt  to 


34 


GENERAL  CONSIDERATIONS. 


cure  it ; but  as  practising  physicians  and  philanthropists,  the  allevia- 
tion and  cure  of  disease  must  be  the  grand  desiderata.  Yet  it  has 
been  lamentable  to  witness  the  almost  exclusive  attention,  which  has 
been  paid  by  many,  of  late  years,  to  diagnosis.  In  hospital  practice 
especially,  the  main  object  of  the  attending  physician  has  too  often 
appeared  to  be,  to  discover,  by  physical  signs  and  vital  phenomena, 
the  precise  disease,  and  then  the  treatment  has  been  left  to  the  resi- 
dent student;  — the  former  priding  himself  on  his  skill  and  attention  to 
the  science^  whilst  he  leaves  to  the  latter  what  he  considers  to  be  the 
art  of  medicine. 

Hematology,  or  observation  of  the  blood  in  disease,  has  been 
usurping,  of  late,  the  attention  of  observers  in  France  especially,  to 
the  exclusion  of  many  other  important  topics  of  inquiry.  Blood  is 
drawn  in  almost  all  diseases,  in  order  to  detect,  by  the  nicest  evalua- 
tion, the  ratio  of  its  main  constituents  to  each  other  ; and  after  this 
has  been  determined,  but  little  attention  is  in  too  many  cases  paid  to 
treatment.  The  same  exclusivism  was  observable,  when,  a few 
years  ago,  pathological  anatomy  was  cultivated  as  the  one  thing 
needful : and  when,  — in  France,  as  elsewhere,  — morbid  specimens 
were  sought  after,  collected,  arranged  and  classified  with  a zeal  and 
enthusiasm  w'hich  had  no  bounds,  and  tolerated  no  opposition. 

Now,  the  attention  to  pathological  anatomy  is  on  the  wane  : and 
it  will  not  be  surprising,  after  the  numerous  mutations  that  have  oc- 
curred, if  this  valuable  aid  to  diagnosis,  and  in  a less  degree  to  the- 
rapeutics, should  experience  the  fate  of  whatever  has  been  supported 
by  exclusivism  ; and  sink  as  far  below  its  due  estimation,  as  it  pre- 
viously soared  above  it.  Against  such  a result  it  behoves  every 
friend  of  science  and  humanity  to  exert  himself  manfully. 

In  the  early  part  of  this  century,”  says  a recent  able  reviewer  of 
the  ‘‘  Practice  of  Medicine”  of  the  author,  in  the  British  and  Foreign 
Medical  Review,  “ especially  after  the  publication  of  the  works  of 
Laennec,  the  current  of  the  public  mind  set  strongly  towards  patholo- 
gical anatomy.  Great  expectations  were  entertained  from  it,  and 
were,  to  some  extent,  realised  in  the  improvement  of  diagnosis.  But 
this  result  was  not  of  a nature  perfectly  to  satisfy  the  spirit — essen- 
tially utilitarian  — of  the  profession  in  this  country.  They  might  for 
a time  study  medicine  as  an  abstract  science,  but  it  would  only  be 
in  the  expectation  of  improvements  in  the  art  speedily  resulting  from 
it.  But  these  results  did  not  necessarily  or  speedily  flow  from  patho- 
logical research.  To  recognise  and  name  a disease  was  found  to  be 
one  thing;  to  cure  it,  another  : the  latter  did  not  flow  as  a corollary 
from  the  former  : it  occurred  as  a contingency  infinitely  more  rare 
than  was  expected  ; and  disappointment  was  the  result.  A change 
came  o’er  the  spirit  of  the  age;  ^ we  want  books  useful  at  the  bed- 
side’ was  the  cry  ; and,  at  once,  as  an  indication  of  the  existence 
of  this  demand,  and  as  a supply  to  meet  it,  the  press  poured  fourth 
‘ Cyclopaedias  of  Practical  Medicine,’  ‘ Libraries,’  ‘ Dictionaries,’ and 
treatises  on  the  same  subject,  in  rapid  succession,  from  Craigie  to 


GENERAL  CONSIDERATIONS. 


35 


Watson.  Our  trans-atlantic  brethren  abate  nothing,  as  is  well  known, 
of  the  practical  and  utilitarian  character  of  the  Anglo-Saxon  race, 
whence  they  are  descended,  and  were  just  as  likely  as  ourselves  to 
be  soon  weary  of  contemplating  and  classifying  morbid  products  as 
some  would  objects  of  natural  history,  provided  they  led  to  no  toler- 
ably prompt  result  in  the  saving  of  life,  or  the  alleviation  of  suffering. 
With  them,  too,  the  demand  is  for  therapeutics,  and  to  meet  this 
demand  we  have  (with  others)  the  work  of  Dr.  Dunglison.” 

The  signal  difference  between  the  numerical  investigation  of  dis- 
ease, and  of  therapeutical  agencies,  it  is  to  be  apprehended,  must  con- 
tinue. It  may  be  diminished,  but  can  never  perhaps  be  removed. 
An  accurate  appreciation  of  facts — of  numerouswell  observed  facts — 
is  essential  to  both.  A knowledge  of  the  healthy  and  diseased  func- 
tions, or  of  physiology  and  pathology,  and  of  the  ordinary  effects  of 
therapeutical  agents  on  those  functions,  obtained  by  careful  and  re- 
peated observation,  must  be  the  basis  of  that  enlightened  theory, 
which  necessarily  leads  to  enlightened  practice  ; and  great  mischiejf 
would  result  to  both,  were  we  to  discard  all  rational  therapeutics, 
and  restrict  ourselves  to  mere  observation.  The  complex  functions, 
executed  by  the  human  organism,  are  so  modified  by  multitudinous 
external  and  internal  influences,  which  are  inappreciable  ; so  much 
agency  is  perpetually  exerted  by  the  moral  over  the  physique,  that 
no  comparable  facts  can  be  obtained  in  sufficient  number  to  admit  of 
any  accurate  numerical  deduction  ; and,  constantly,  we  must  either 
treat  disease  in  accordance  with  principles  suggested  by  conjoined 
observation  and  reason  ; experiment  for  ourselves  ah  initio  ; or  resign 
our  faith  to  the  asserted  observation  and  experience  of  others  ; and 
of  these,  which  of  the  legion  shall  we  select  as  masters  ^ It  is  for- 
tunate that  we  are  possessed  of  such  principles  in  medicine.  With- 
out them  we  should  be  unable  to  meet  morbid  manifestations,  which 
present  themselves  to  us  for  the  first  time.  “ He,”  — says  Dr.  Aber- 
crombie, — who  follows  certain  arts  or  practical  rules,  without  a 
knowledge  of  the  science  on  which  they  are  founded,  is  the  mere 
artizan  or  the  empiric  ; he  cannot  advance  beyond  the  practice  rules 
which  are  given  him,  or  provide  for  new  occurrences  and  unforeseen 
difficulties.” 

These  great  principles  are  the  same  every  where,  and  by  their 
possession  we  can  combat  disease  wherever  we  meet  with  it ; 
amongst  the  equatorial  heats,  or  the  Siberian  snows  ; in  the  scorch- 
ing presidencies  of  British  India,  and  a fortiori  in  every  portion  of  this 
wide-spread  territory  ; the  lofty  mountain,  and  the  lowly  valley  ; the 
pestiferous  locality  on  the  banks  of  the  Mississippi,  and  the  more 
salubrious  regions  where  malarious  influence  is  unknown.  It  is  by 
their  possession,  that  the  medical  officers  of  the  army  and  navy 
know  how  to  manage  the  diseases  of  all  climes,  when  opportunity 
is  offered  them  for  adequate  observation.  That  diseases  are  modified 
by  climate  or  locality  cannot  be  doubted,  but  the  well  instructed 
physician  speedily  seizes  hold  of  the  peculiarity. 


36 


G K N K 11 A L CONSIDERATIONS. 


It  behoves  the  student  to  observe  well  for  himself,  carefully,  re- 
peatedly ; yet  to  discard  not  the  observations  of  others  ; to  reject 
not  at  once  as  apocryphal,  or  to  hold  as  of  no  binding  authority,  all 
the  traditions  of  the  fathers,  unless  they  are  sustained  and  sanc- 
tioned by  his  own  experience  ; but  rather  to  respect  them,  and  believe 
it  possible  that  his  own  observation  may  have  been  defective.  Un- 
der such  feelings,  let  him  subject  them,  on  the  part  of  himself  and 
others,  to  repeated  scrutiny  ; and  then,  but  not  till  then,  abandon 
them,  should  they  appear  to  be  wanting  in  accuracy.  Let  him  imbue 
himself  profoundly  with  the  great  principles  of  physiology  and  patho- 
logy, simple  and  applied  ; regard  pathological  anatomy  as  an  aid, 
but  an  aid  only,  to  diagnosis  and  therapeutics  ; endeavour  to  com- 
prehend well  the  action  of  his  remedies,  and  the  great  principles  of 
general  therapeutics  ; and  thus,  fortified  and  guided  by  all  the  lights, 
which  illumine  the  profession  in  its  present  advanced  and  advancing 
condition,  he  will  be  enabled  to  shine  as  the  well  informed,  observ- 
ing, and  rational  practitioner,  happy  in  his  own  resources,  and  a bless- 
ing to  the  community  whose  confidence  is  reposed  in  him. 


THERAPEUTICAL  INDICATIONS. 


37 


CHAPTER  II. 

CIRCUMSTANCES  THAT  MODIFY  THERAPEUTICAL  INDICATIONS. 

Age — Sex — Original  conformation — Habit — Climate — Mental  affections — Professions, 
and  way  of  life — Causes,  seat,  period,  &c.,  of  the  disease. 

• 

Having  briefly  alluded  to  the  great  principles  that  ought  to  guide 
the  physician  in  laying  down  his  indications  of  cure,  it  will  be  pro- 
per to  glance  at  some  of  the  chief  circumstances  that  contribute  to 
modify  those  indications  in  the  treatment  of  disease.  In  all  cases, 
general  principles  are  to  guide  the  practitioner,  but  as  he  has  to  treat 
individuals,  circumstances  may  be  connected  with  them  w^hich  de- 
mand important  modifications. 

The  circumstances  of  a modifying  nature  are  many.  Some  are 
connected  with  age,  conformation,  sex,  professions,  habit,  &c.;  others 
with  the  causes,  seat,  intensity,  period,  &c.,  of  the  malady. 

1.  AGE. 

This  has  considerable  influence,  especially  as  connected  with  the 
different  evolutions,  which  the  system  experiences  in  the  progress  of 
life,  and  which  give  occasion  to  diseases  at  one  period  of  existence, 
that  do  not  occur  at  others,  and  thus  modify  both  the  rules  of  Hygi- 
ene, and  Therapeutics. 

In  early  infancy,  there  is  great  nervous  susceptibility  or  impressi- 
bility, so  that  mischief  is  liable  to  be  produced  in  the  encephalon 
from  slight  irritations.  On  this  account,  before  and  during  the  pe- 
riod of  the  first  dentition,  the  surgeon  avoids  performing  any  operation 
which  he  is  not  compelled  to  undertake.  For  the  same  reason,  den- 
tition itself  is  the  cause  of  many  phenomena  of  a sympathetic  charac- 
ter, which  can  often  be  relieved  only  by  attending  to  the  condition  of 
the  gum.  Irritation  in  the  intestines  is  also  the  cause  of  many  mor- 
bid affections  ; and  the  nervous  impressibility,  before  referred  to, 
causes  them  not  to  bear  narcotics  well.  Again,  under  two  years  of 
age,  large  quantities  of  mercury  maybe  given  without  the  superven- 
tion of  the  ordinary  effects  of  the  medicine  on  the  system.  It  is  ex- 
tremely difficulty  to  salivate  a child  under  two  years  of  age,  and  yet 
at  three,  and  afterwards,  it  is  easy.  This  must  be  dependent  upon 
some  singular  evolution,  some  different  condition  of  the  absorbent 
function,  which  is  inappreciable  in  the  present  state  of  our  know- 
ledge. The  mortality  at  this  period  of  existence  is  very  great,  one 
third  of  the  whole  number  of  deaths  in  our  cities  occurring  under  two 
VOL.  I. — 4 


38 


THERAPEUTICAL  INDICATIONS 


years  of  age.  In  addition  to  the  great  tendency  to  disease  of  the 
oerebro-spinal  axis,  we  find  in  summer  a disposition  to  erethism  of 
the  skin  and  'mucous  membrane  of  the  bowels  ; and  in  winter  to  a 
similar  condition  of  the  mucous  membrane  of  the  pulmonary  appara- 
tus : accordingly,  cutaneous  eruptions,  aphthse,  diarrhoea,  cholera, 
croup,  bronchitis,  &c.,  are  common  at  this  age,  owing  to  the  suscep- 
tibility to  disease  of  the  dermoid  tissue  ; and  convulsions,  hydroce- 
phalus (cephalitis)  and  other  head  affections,  owing  to  the  impressi- 
bility of  the  nervous  system.  During  the  whole  of  this  period,  a 
predominance  of  acidity  is  manifested  in  the  stomach,  either  owing 
to  an  undue  secretion  of  the  acids  met  with  in  that  organ  in  health, 
or  to  the  reaction  of  the  elements  of  the  food  on  each  other,  or  to 
both  ; and  hence  an^ids  are  indicated,  as  well  as  occasional  laxa- 
tives. The  state  of  erethism  in  the  mucous  membrane  of  the  intes- 
tines lays  the  foundation,  in  scrofulous  habits,  to  mesenteric  gan- 
glionitis, and  to  consequent  tabes  mesenterica,  in  the  same  manner  as 
a wound  in  the  hand  or  foot  occasions  axillary  or  inguinal  gan- 
glionitis. 

Between  the  age  of  the  first  dentition  and  puberty,  including  the 
whole  of  childhood,  the  liability  to  the  affections  that  were  so  fatal 
during  the  first  two  years  of  existence  becomes  amazingly  diminish- 
ed ; and  the  peculiarities  of  this  early  stage  of  existence  gradually, 
and  totally  cease. 

At  and  after  the  age  of  puberty,  a surprising  change  is  observa- 
ble. A complete  revolution  has  been  effected  in  the  economy  by 
the  development  of  the  generative  apparatus.  The  morbid  ten- 
dency is  now  to  the  lungs  ; and  consumption  — that  dread  disease, 
which,  in  these  climates,  is  estimated  to  destroy  at  least  one-sixth  of 
the  population — is  rife. 

During  the  whole  period  of  virility  no  particular  modification  is 
produced  by  the  evolution  of  organs.  All  goes  on  with  greater  uni- 
formity, so  that  no  new  morbid  tendency  seems  to  be  developed. 
It  is  the  standard  period  for  all  our  physiological  and  therapeutical 
descriptions,  unless  otherwise  specified.  If  we  speak  of  the  dose  of 
a medicine  abstractedly,  we  mean  the  quantity  usually  needed  by  an 
adult  male  to  procure  the  ordinary  effects  of  the  drug. 

Lastly  : — in  old  age,  the  nervous  susceptibility  becomes,  in  gene- 
ral, diminished,  so  that  larger  doses  — of  particular  kinds  of  remedies 
at  least  — are  needed,  and  a greater  supply  of  food  is  demanded,  in 
order  tfiat  the  enfeebled  powers  of  chylosis  may  be  able  to  extract 
from  ii^he  adequate  supply  of  chyle.  The  torpor  of  the  intestinal 
functions  is  at  times  so  great,  that  the  excrement  collects  in  quanti- 
ties in  the  lower  part  of  the  bowels,  and  occasionally  becomes  so 
much  indurated,  that  mechanical  means,  — as  enemata,  or  the  use  of 
a scoop,  — are  needed  for  its  removal.  The  tendency,  too,  to  dis- 
ease of  the  urinary  organs,  and  especially  of  the  prostate  and  blad- 
der, is  considerable  at  this  time  of  life,  and  but  few  individuals  attain 
the  age  of  eighty,  without  being  more  or  less  incommoded  in  this 
manner. 


MODIFIED  BY  SEX. 


39 


Connected  with  the  pathology  of  old  age,  M.  Begin  has  laid 
down  the  too  general  law,  — that  in  the  greater  part  of  old  people, 
disease  is  the  result  of  chronic  irritations,  produced  in  the  organs  by 
the  long  continued  repetition  of  the  stimulations  that  accompany  the 
regular  exercise  of  the  functions  ; — but  this  is  improbable.  It  can- 
not readily  be  conceived  how  any  continuance  of  healthy  stimula- 
tions should  bring  on  disease  in  these  or  other  parts.  In  the  ex- 
hausted condition  of  the  nervous  agency,  obstruction  or  irregularity 
of  action  is  apt  to  be  induced  ; and  such  obstruction,  or  any  morbid 
deposition,  dependent  upon  irregularity  of  action,  thus  becomes  the 
source  of  irritation,  and  organic  disease.  All  the  morbid  affections, 
indeed,  of  old  age  are  irritative  as  at  other  ages.  Chronic  gastritis, 
ascites,  enlarged  liver,  visceral  engorgements,  chronic  bronchitis  in 
all  its  forms,  asthma,  angina  pectoris,  chronic  affections  of  the  heart 
in  general,  are  diseases  of  irritation,  originating  in  some  irregu- 
larity, not  in  the  simple  continued  healthy  action  of  the  organs  im- 
plicated, or  in  debility. 

At  all  ages,  then,  the  treatment  of  disease  must  be,  in  its  general 
principles,  the  same  ; but  it  requires  to  be  varied  according  to  the 
strength  of  the  individual,  and  the  evolution  of  the  organs  at  different 
periods  of  existence. 

2.  SEX. 

Prior  to  the  period  of  puberty,  there  are  but  few  points  of  differ- 
ence, so  far  as  relates  to  therapeutics,  between  the  two  sexes.  From 
organisation,  there  is  a greater  mobility  and  impressibility  in  the  ner- 
vous system  of  the  female,  but  this  is  not  marked  before  she  becomes 
nubile,  or  before  the  genital  apparatus  has  experienced  the  evolution 
vrhich  befals  it  at  puberty.  After  this,  all  the  functions  are  apt  to 
be  modified  by  the  new  condition  of  the  uterine  organs.  A periodi- 
cal discharge  is  established,  and  if  this  be  in  any  manner  interfered 
with,  the  organic  irritation,  which  ought  to  have  existed  there,  is 
transferred  to  other  parts,  and  the  one  most  predisposed  to  take  on 
morbid  action  assumes  it.  Hence  it  is  that  attention  has  always  to 
be  paid  to  the  state  of  this  function,  when  the  therapeutist  is  called 
upon  to  examine  other  functions  that  may  be  deranged,  and  may  be 
obscurely  connected  with  the  uterine  functions,  through  the  extensive 
sympathy  which  they  maintain.  This  is  signally  manifested  when 
the  catamenia  do  not  appear  at  the  usual  age ; or  when,  after  having 
occurred  regularly,  they  become  obstructed.  Whilst  the  catamenia, 
too,  are  flowing,  the  female  is  generally  extremely  impressible,  so 
that  active  remedies  — especially  such  as  affect  the  lower  part  of  the 
bowels,  or  the  urinary  organs,  and  excite  the  uterus  through  conti- 
guous sympathy — have  to  be  used  with  caution. 

The  period  at  which  the  catamenia  cease  is  also  one  of  interest  to 
the  therapeutist.  The  female  is  then  so  proverbially  liable  to  irre- 
gularity in  the  functions,  and  in  the  nutrition  of  organs,  that  it  has 
been  called,  even  by  the  unprofessional— “ the  critical  period,” 


40 


THERAPEUTICAL  INDICATIONS 


Prior  to  their  total  disappearance  the  catamenia  may  recur  irregu- 
larly ; chronic  irritations  may  thus  be  developed  in  the  sexual  or- 
gans, or  elsewhere.  The  mammse,  having  lost  the  sympathetic  influ- 
ence exerted  between  them  and  the  uterus,  are  apt  to  assume  a mor- 
bid condition,  and  to  become  the  seat  of  irritations  of  a specific 
kind  — as  of  cancer  — which  appeared  to  be  previously  held  in 
check  by  the  play  of  the  healthy  sympathies.  Yet,  although  the 
female  is  more  liable  to  disease  at  this  time,  it  would  not  seem  from 
the  results  of  statistical  inquiry  that  the  mortality  is  increased. 

It  is  obvious,  then,  that  the  state  of  the  uterine  function  must  be 
an  important  object  of  inquiry  in  many  of  the  diseases  to  which 
the  sex  is  liable  ; that  when  the  catamenia  are  present,  the  flow 
must  not  be  officiously  interfered  with ; and  if  modified,  either 
owing  to  the  proper  periodical  irritation  having  been  arrested,  or  to 
the  flow  occurring  in  too  great  quantity,  appropriate  measures  for 
altering  these  conditions  must  be  had  recourse  to. 

At  one  time,  it  was  universally  presumed,  that  hysteria  is  occa- 
sioned altogether  by  the  state  of  the  uterus,  and  hence  its  name, 
from  “the  uterus,”  and  the  German  name  — Mutterkrank- 

heitj  or  “womb  disease.”  It  occurs,  however,  in  man;  is  essen- 
tially a disease  of  the  nervous  system,  and  probably  prevails  more 
in  females  only  because  they  possess  greater  mobility,  and  irrita- 
bility of  the  nervous  system,  — doubtless  often  developed  by  the 
particular  condition  of  the  uterus  reacting  on  the  nervous  system, 
but  manifestly  appearing  — as  in  the  male  — where  no  such  influ- 
ence can  be  presumed.  The  presence  of  the  uterine  system  consti- 
tutes, therefore,  the  main  difference  in  the  indications  to  be  laid 
down  for  the  treatment  of  female  diseases,  as  well  as  in  the  mode 
of  fulfilling  those  indications  ; and  in  all  cases  the  therapeutist  has 
to  carefully  inquire,  whether  that  system  be  primarily  or  secondarily 
affected.  In  many  cases  of  functional  aberration  of  the  uterus,  he 
will  find,  that  the  cause  is  seated  perhaps  in  the  state  of  the  general 
system,  or  in  some  other  part  of  the  organism,  although  the  case  may 
be  much  complicated,  in  consequence  of  the  reflection  of  the  uterine 
irritation  to  other  organs. 

After  all,  the  treatment  of  the  majority  of  the  diseases,  that  attack 
females  as  well  as  males,  must  be  based  upon  the  same  great  general 
principles ; the  chief  modifying  circumstance  to  be  borne  in  mind 
being,  that  the  female  is  more  susceptible  of  impressions  than  the 
male,  and  consequently,  as  a general  rule,  does  not  require  the  same 
amount  of  remedial  agents,  although  the  same  agents  may  be  de- 
manded. In  managing  diseases  that  are  of  a sexual  character,  the 
same  great  modifying  circumstance  has  to  be  recollected. 

In  the  anomalies  that  occur  at  the  commencement,  or  cessation  of 
menstruation,  the  pathologist  must  be  guided  by  his  acquaintance 
with  the  laws  of  physiology  and  pathology,  and  establish  his  indica- 
tions accordingly. 

4'he  state  of  utero-gestation  is  a point,  connected  with  the  female. 


MODIFIED  BY  SEX. 


41 


which  demands  consideration.  The  various  sympathetic  disorders, 
that  may  arise,  have  to  be  palliated  by  the  most  gentle  agents.  The 
original  cause  being  seated  in  the  gravid  uterus  cannot,  of  course,  be 
removed,  and  palliation  alone  remains.  No  violent  medicinal  agents 
can  be  prescribed  without  hazard.  Powerful  excitants  are  especially 
objectionable  ; and  hence  the  hot  bath  cannot  be  used  with  impu- 
nity. Any  thing  that  interferes  with  the  due  nutrition  of  the  fetus 
in  utero,  or  that  can  give  occasion  to  uterine  contraction,  is  obvi- 
ously improper.  It  is  necessary,  also,  to  bear  in  mind,  that  the  blood 
of  the  pregnant  female  usually  presents  the  huffy  coat,  or  that  ap- 
pearance, which  has  been  so  generally  regarded  as  the  universal  pro- 
duct of  inflammation  as  to  be  called  the  “ inflammatory  crust and 
it  is  still  maintained  by  some,  that  this  crust  on  the  blood  of  pregnant 
women  only  appears  when  inflammatory  irritation  exists.  Certain, 
however,  it  is,  that  we  witness  it,  when  there  are  no  other  signs  of 
inflammation.  When  the  crust  occurs  in  inflammation,  it  has  been 
considered  to  be  owing  to  the  vitality  of  the  blood  being  exalted, 
so  that  it  is  longer  in  coagulating,  and  time  is  thus  allowed  for  the 
subsidence  of  the  red  globules  to  the  bottom  of  the  vessel.  The 
fibrin,  devoid  of  red  globules,  then  forms  the  upper  crust  or  stratum, 
which  is  the  huff.  In  like  manner,  it  might  be  understood,  that 
under  the  new  draughts,  which  are  indirectly  made  from  the  mater- 
nal blood,  during  pregnancy,  its  vitality  may  be  exalted,  so  as  to 
give  rise  to  the  phenomenon  in  question.  As  a general  rule,  the 
pathologist  regards  the  appearance  of  the  crust  on  the  blood,  as  a 
strong  proof  of  the  presence  of  inflammation  ; and,  when  he  would 
otherwise  have  remained  in  doubt,  is  encouraged,  by  this  sign,  to 
repeat  blood-letting.  In  pregnancy,  such  an  inference  from  the  ap- 
pearance of  the  blood  drawn  might,  for  the  reasons  stated  above,  be 
erroneous;  yet  in  many  parts  of  this  country,  it  is  not  unusual  for  a 
female  to  be  bled  five  or  six  times  during  the  period  of  pregnancy: — - 
often  three  or  four  times;  and  if  blood  should  not  have  been  drawn, 
and  any  unfortunate  event  should  occur,  it  is  apt  to  be  ascribed  to  a 
neglect  of  this  fancied  prophylactic.  It  is  strange  that  a process, 
which  every  one  would  readily  admit  to  be  natural  in  the  animal, 
and  to  require  no  remedial  means,  should  be  regarded  as  a patholo- 
gical condition.  The  notion  has,  however,  been  encouraged  by 
some  of  the  medical  profession  of  no  little  celebrity,  especially  by 
Sauvages,  who  places  pregnancy  in  the  order  Intumescentice  of  his 
Nosology,  and  by  Linnaeus,  who  ranges  it  under  tumidosi  (morbi). 

During  the  perod  of  nursing,  the  practitioner  has  to  attend  to 
another  circumstance;  viz.,  that  the  action  of  his  medicinal  agents 
may  not  be  confined  to  the  female  ; for  the  infant  at  the  breast  may 
be  affected  likewise.  Absorption  is  active,  in  consequence  of  the 
constant  secretion  from  the  mammae,  and  certain  substances  may, 
therefore,  be  taken  up,  in  sufficient  quantity  to  affect  the  child  iqv 
juriously. 

4=^ 


42 


THERAPEUTICAL  INDICATIONS 


L ORIGINAL  CONFORMATION. 

There  are  many  circumstances,  connected  with  original  conforma- 
tion, which  exert  a modifying  influence,  both  hygienically  and  thera- 
peutically. Singular  as  it  may  seem,  it  is  indubitable,  that  from  the 
moment  of  a fecundating  copulation,  the  new  being  is  impressed 
with  an  impulse,  which  gives  occasion  to  such  a formation  as  may 
predispose  the  offspring,  at  some  period  of  its  existence,  to  a disease 
that  affected  the  male  or  the  female  parent.  In  this  way,  a conform- 
ation may  result,  which  may  favour  the  development  of  consump- 
tion, apoplexy  or  scrofula,  under  the  action  of  adequate  exciting 
causes,  at  certain  ages.  Hence  it  is,  that  we  find  so  much  difference 
in  the  constitutions  of  different  persons.  The  constitution  of  an  indi- 
vidual is  the  organisation  proper  to  him  ; and  he  is  said  to  have  a 
strong,  or  a delicate,  a good,  or  a bad  constitution,  when  he  is  ap- 
parently strong  or  feeble,  — usually  in  good  health,  or  liable  to  re- 
peated attacks  of  disease.  The  varieties  of  constitution  are,  there- 
fore, as  numerous  as  the  individuals  themselves.  A strong  constitu- 
tion is  considered  to  be  dependent  upon  a due  development  of  the 
principal  organs  of  the  body ; on  a happy  proportion  between  those 
organs  ; and  on  a fit  state  of  energy  of  the  nervous  system  ; whilst  a 
feeble  or  weak  constitution  results  from  a want  of  these  postulates ; 
but  it  is  obvious,  that  our  knowledge  on  this  matter  must  be  some- 
what limited,  although,  by  a careful  examination,  we  may  be  able 
to  appreciate  or  rather  to  approximate  it. 

It  is  daily  observed,  in  our  intercourse  with  man,  in  a state  of 
health,  or  of  disease,  that  some  persons  possess  much  more  irritability 
or  impressibility  than  others.  This  irritability  or  impressibility  is 
mainly  seated  in  the  nervous  system,  and  through  it  every  tissue  of 
the  body  may  be  affected,  by  virtue  of  the  contractility  or  excitability 
which  it  possesses. 

Men  certainly  have  very  different  degrees  of  nervous  energy  ; and 
of  susceptibility  to  impressions  ; and  consequently  great  diversity  in 
the  degree  to  which  they  are  predisposed  to  disease,  and  in  the  action 
of  remedies.  Persons  of  very  great  nervous  susceptibility  are  sensibly 
alive  to  atmospheric  vicissitudes  ; have  the  Ccenccsthesis,  or  common 
feeling,”  Gem.eingefuhl  oi  the  Germans,  extremely  acute ; are  languid, 
listless,  and  depressed  in  a lowering  atmosphere  ; buoyant,  and  elastic, 
ort“  corky”  — to  use  the  language  of  the  “ trainers”  — when  the  air  is 
dry  and  serene.  We  see  the  same  variety  in  the  way  in  which 
powerful  emotions,  or  powerful  impressions  of  the  senses,  affect  dif- 
ferent individuals.  Some  persons  faint  on  the  slightest  shock  made 
on  any  of  the  senses  ; others  are  thrown  into  convulsions  by  causes, 
which,  in  others,  again,  would  excite  no  perceptible  emotion.  The 
over-excitement  of  a nervous  individual  concerns  ns  materially,  in 
the  application  and  effects  of  our  therapeutical  agents.  With  such 
individuals,  the  slightest  cause  may  produce  fever,  owing  to  the 
irritation  of  the  nervous  system  extending  to  the  vascular  system, 


MODIFIED  BY  CONSTITUTION. 


43 


and  causing  in  it  augmented  action.  Usually,  the  febrile  irritation, 
thus  induced,  is  only  ephemeral;  but  if  there  be  any  part  of  the 
capillary  system,  owing  to  obstruction,  or  morbid  derangement, 
strongly  predisposed  to  assume  the  inflammatory  condition,  such  a 
condition  may  be  induced  by  the  force  with  which  the  blood  is  pro- 
pelled by  the  heart  and  arteries.  The  circulatory  system  is  not 
directly  influenced  by  the  brain  or  spinal  marrow,  but  it  is  so  indi- 
rectly. We  see  this  in  the  effect  of  emotions.  The  heart  leaps  with 
joy  ; and  under  the  influence  of  certain  passions  its  actions  are  hur- 
ried and  unequal.  Nay,  the  effect  extends  even  to  the  small  vessels, 
— to  those  by  which  secretion  is  operated  in  the  glandular  system. 
At  the  sight  of  a cherished  article  of  food,  the  salivary  glands  secrete 
so  rapidly  as  to  cause  the  mouth  to  water,”  and  the  saliva  to  be  pro- 
jected from  it. 

It  is  an  important  principle,  not  to  be  lost  sight  of  in  Therapeutics, 
that  the  condition  of  the  circulatory  system  is  largely  influenced  by 
that  of  the  nervous  system  ; and  it  is  especially  important  to  bear 
this  in  mind  in  the  management  of  febrile  and  inflammatory  diseases. 
If  blood-letting  be  pushed  to  a very  great  extent,  in  such  cases,  it 
will  induce  irregularity  of  action,  and  irritability  of  the  nervous  sys- 
tem, and  in  this  way  local  determinations  may  be,  and  often  are,  in- 
duced by  the  very  means  employed  to  obviate  thei^.  This  effect  of 
copious  loss  of  blood  is  instructively  exemplified  in  uterine  hemor- 
rhage. A female,  after  delivery,  may  be  reduced  to  death’s  door  by 
the  profuse  discharge  of  blood.  She  may  be  almost  pulseless,  pale, 
and  exanguious  ; and  yet,  in  the  course  of  a few  hours  after  she  has 
rallied,  the  most  violent  determination  may  take  place  to  the  head  — 
as  indicated  by  intolerable  cephalalgia  and  violent  throbbing  of  the 
carotid,  and  temporal  arteries  ; — a state  induced  by  the  irregularity 
above  described  as  apt  to  be  engendered  by  that  irritability  of  the 
nervous  system,  which  follows  a profuse  discharge  of  blood.  In  such 
a case,  farther  blood-letting  obviously  cannot  be  indicated.  The  ir- 
ritability of  the  nervous  system  must  first  be  allayed ; and  accordingly, 
the  author  has  found  the  most  decided  advantage  from  the  use  of 
opium,  administered  in  such  a dose,  and  in  such  a form,  as  to  ensure 
the  speedy  production  of  its  full  sedative  influence.  When  this 
begins  to  be  exerted,  the  activity  of  the  cephalic  circulation  gradually 
yields  ; and  in  a short  time  the  whole  mischief  disappears.  If  blood- 
letting be  had  recourse  to  in  such  a case,  — even  to  a moderate  ex- 
tent, and  it  could  not  be  carried  far  in  this  reduced  state  of  the  system, 
— it  is  calculated  to  augment  the  very  pathological  condition  which 
it  was  intended  to  remove.  The  advantage  attending  a union  of 
copious  bleeding  with  sedative  doses  of  opium  can  thus  be  readily 
appreciated.  The  abstraction  of  blood  reduces  the  amount  of  stimulus 
in  the  sanguiferous  system,  whilst  the  opium  keeps  down  the  excite- 
ment of  the  nervous  system. 

In  particular  diseases,  the  nerves  are  remarkably  susceptible  to 
impressions.  In  neuralgia  faciei,  the  slightest  motion  of  the  mus- 


44 


THERAPEUTICAL  INDICATIONS 


cles  — the  least  breath  of  air — induces  the  most  excruciating  tor- 
ment ; and  in  hydrophobia,  the  distress  and  horror  are  chiefly  occa- 
sioned by  the  impression  of  certain  objects  on  the  organ  of  sight. 
Some  persons,  again,  suffer  much  more  from  pain  than  others.  This 
is  the  case  with  different  animals,  and  it  is  equally  so  with  different 
men.  The  idea,  that  the  beetle,  when  trod  upon,  feels  as  much  as 
the  giant  when  he  dies,  is  poetical,  but  probably  untrue.  Some  per- 
sons are  thrown  into  the  greatest  nervous  distress  — the  most  intole- 
rable anguish  — by  the  application  of  a blister;  and  it  is  well  known, 
tliat  all  do  not  bear  surgical  operations  equally  well.  This  is  doubt- 
less greatly  dependent  upon  organisation,  although  it  maybe  modified 
by  habits  of  endurance,  or  the  contrary.  The  state  of  the  mind  exerts 
a powerful  influence  in  this  respect.  The  religious  fanatic,  and  the 
martyr  to  political  excitement,  have  exhibited  a resistance  to  physical 
agents  almost  incredible. 

The  condition  of  the  nervous  system  can  never  be  wholly  disre- 
garded by  the  therapeutist.  Whenever  it  is  morbidly  impressed, 
the  operation  of  medicines  is  interfered  with  ; and  regular  physiolo- 
gical actions  may  be  modified.  We  see  this  last  effect  exhibited  in 
the  parturient  female.  Labour  may  have  been  proceeding  in  the 
most  favourable  manner,  but  if  any  thing  should  interfere  with  the 
attendance  of  th^  practitioner  who  has  been  expected,  and  another 
should  present  himself ; and  still  more,  if  the  latter  should  have  an 
unprepossessing  appearance,  the  pains  may  subside,  and  the  delivery 
be  greatly  retarded ; whilst  if  the  accoucheur,  in  whom  the  female 
had  reposed  her  confidence,  had  presented  himself,  the  termination 
might  have  been  as  much  facilitated.  Dr.  A.  T.  Thomson  gives  the 
following  anecdote  as  illustrative  of  the  control  of  the  mind  over  the 
operation  of  medicines,  where  the  whole  effect  must  obviously  have 
been  induced  through  the  nervous  agency  modifying  the  functions  of 
the  organs  concerned.  A lady  was  labouring  under  an  affection  of 
the  bowels,  attended  with  severe  pain  and  the  most  obstinate  cos- 
tiveness. She  was  bled ; the  warm  bath,  and  fomentations  were 
frequently  resorted  to  ; and  purgatives  and  various  anodynes  were 
freely  administered,  but  without  the  least  effect  upon  the  bowels, 
and  without  either  sleep,  or  any  diminution  of  pain  ensuing.  At 
length,  the  physician  in  attendance  was  informed  that  she  had  ex- 
pressed her  conviction,  that  her  usual  medical  attendant,  who  was 
in  the  country,  alone  understood  her  constitution,  and  was  the  only 
person  who  could  relieve  her.  This  gentleman  was  accordingly  sent 
for ; and  although  no  change,  either  of  measures,  or  of  medicine, 
was  resorted  to,  the  bowels  were  quickly  moved ; sleep,  and  a ces- 
sation of  pain  followed,  and  in  a few  days  the  patient  was  conva- 
lescent. He  further  remarks,  that  he  has  witnessed  frequent  illustra- 
tions of  this  influence  of  mind  in  modifying  the  effects  of  medicines, 
in  the  treatment  of  gonorrhoea  contracted  by  married  men  ; and  also 
by  young  men,  possessed  of  a high  feeling  of  moral  rectitude.  The 
anxiety  of  such  persons  to  be  speedily  cured  occasions  the  mind  to 


MODIFIED  BY  TEMPERAMENTS. 


45 


be  constantly  directed  to  the  seat  of  the  disease ; and  more  or  less 
erethism  is  thus  induced  there,  which  renders  the  cure  difficult.  Dr. 
Thomson  thinks,  that  a vascular  fulness  of  the  mucous  membrane, 
and  a state  resembling  chronic  inflammation  ’’  are  thus  superinduced, 
which  resist  the  influence  of  medicines,  that  would  readily  cure  the 
disease  in  those  in  whom  it  was  a matter  of  less  anxiety,  and  little 
mental  reflection.  It  is  obviously,  therefore,  of  moment,  in  all  affec- 
tions, particularly  in  those  of  an  inflammatory  character,  that  the  mind 
should  not  be  permitted  to  brood  over  the  malady ; and  that  every 
endeavour  should  be  made  to  withdraw  the  nervous  influence  from 
the  part  affected,  so  far  as  this  can  be  done  with  propriety.  It  is  in 
this  way,  that  revulsive  applications  exert  a portion  of  their  bene- 
ficial agency.  They  not  only  excite  the  parts  to  which  they  are  ap- 
plied, so  as  to  break  in  upon  the  morbid  catenation  elsewhere  exist- 
ing, but  they  attract  the  attention,  and  the  nervous  influx,  which 
would  otherwise  be  directed  towards  the  suffering  organ,  is  directed 
towards  the  part  artificially  irritated. 

Much  stress  has  been  placed  on  the  influence  of  temperament  in 
a pathological  as  well  as  therapeutical  point  of  view.  The  subject 
of  the  temperaments,  usually  admitted,  belongs  to  physiology.  The 
sanguine ; the  bilious  or  choleric  ; the  melancholic  or  atrabilious  ; the 
phlegmatic^  lymphatic  oy  pituitous^  and  the  nervous  are  generally  re- 
ceived and  described  by  writers  ; but  if  we  attend  to  their  reputed 
characteristics,  the  imperfection  of  their  definition  and  demarcation 
is  obvious ; so  imperfect,  indeed,  are  they,  that  it  is  very  rare  for  us 
to  meet  with  an  individual,  whom  we  could  unhesitatingly  refer  to 
any  one  of  them.  They  are  likewise  susceptible  of  important  modi- 
fications from  climate,  education,  &c.,  and  may  be  so  combined  as 
to  constitute  innumerable  shades.  The  man  of  the  strongest  san- 
guine characteristics  may,  by  misfortune,  assume  all  those,  of  a men- 
tal character  particularly,  which  are  looked  upon  as  indexes  of  the 
melancholic  or  atrabilious  ; and  the  activity,  and  impetuosity,  as- 
cribed to  the  bilious  temperament,  may,  by  slothful  indulgence,  be 
converted  into  the  lymphatic  or  phlegmatic.  All  these  temperaments 
acquired  their  names  from  a fancied  predominance  of  certain  sys- 
tems, which  so  tempered  the  different  functions  as  to  communicate 
certain  evident  characteristics.  In  a therapeutical  consideration, 
they  do  not  demand  much  attention,  except  perhaps  so  far  as  regards 
the  two  opposite  — the  sanguine^  and  the  melancholic  ; and  perhaps 
the  nervous.  The  first  of  these  is  presumed  to  be  dependent  upon  • 
a predominance  of  the  circulatory  system  ; and  hence  is  considered 
to  be  characterised  by  strong,  frequent,  and  regular  pulse  ; ruddy 
complexion ; animated  countenance  ; good  shape,  although  distinctly 
marked  ; firm  flesh  ; light  hair  ; fair  skin ; blue  eyes  ; nervous  sus- 
ceptibility, attended  with  rapid  successibilite  ^ as  the  French  term  it, 
— that  is,  a facility  of  being  impressed  by  external  objects,  and  of 
passing  rapidly  from  one  idea  to  another.  On  the  other  hand,  in 


46 


THERAPEUTICAL  INDICATIONS 


the  melancholic  temperament,  the  vital  functions  are  considered  to 
be  more  feebly  or  irregularly  performed  ; the  skin  has  a deeper  hue  ; 
the  countenance  is  sallow,  or  sad  ; the  bowels  are  torpid,  and  all  the 
excretions  tardily  accomplished  ; the  pulse  is  hard  and  habitually 
contracted.  In  the  nervous  temperament,  again,  the  susceptibility 
of  being  acted  upon  by  external  impressions  is  unusually  developed. 
It  is  characterised  by  small,  soft,  and,  as  it  were,  wasted  muscles  ; 
and  generally  by  a slender  form,  and  great  vividness  of  sensation. 

Such  are  the  characters  ordinarily  assigned  to  these  temperaments. 
Many  of  them  are  fallacious,  and  but  few  need  be  borne  in  mind  in 
therapeutical  investigations.  As  a general  rule,  it  certainly  would 
seem,  that  persons  of  strong  sanguine  characteristics  have  the 
nervous  system  more  impressible  ; the  body  more  predisposed  to  in- 
flammatory action,  and  the  vessels  less  protected  by  the  tissues  in 
which  they  creep,  and  hence  they  are  more  liable  to  obstructions,  as 
well  as  to  hemorrhage  by  rupture  or  transudation  ; and  it  is  manifest, 
that  in  such  an  organisation  antiphlogistics  may  be  more  demanded, 
and  stimulants  ought  to  be  employed  with  more  caution,  than  in 
the  melancholic.  Again,  the  possessor  of  the  nervous  temperament 
may  demand  modifications  of  management,  both  hygienical  and 
therapeutical,  which  may  not  be  suggested  in  those  of  any  of  the 
other  temperaments.  After  all,  however,  we  cannot  deduce  much 
instructive  matter,  for  our  practical  guidance,  from  the  study  of  this 
topic  ; nor  does  it  seem  to  the  author,  that  the  doctrine  of  the  tem- 
peraments in  any  of  its  relations  — physiological  or  psychological  — 
hygienical  or  therapeutical  — is  worthy  of  the  consideration  that  has 
been  bestowed  upon  it.  In  Therapeutics,  the  nature  of  the  diseased 
action  going  on  in  an  organ  is  the  great  object  of  study  ; and  if  our 
thoughts  are  distracted  from  this,  and  directed  to  temperaments  or 
tendencies,  we  may  often  be  greatly  misled.  Some  years  ago,  the 
author  was  requested  to  visit  a lady  for  the  first  time,  in  the  absence 
of  the  regular  physician,  who  had  long  attended  her,  and  had  be- 
come what  is  called  “ acquainted  with  her  constitution.”  She  was 
labouring  under  profuse  metrorrhagia,  which  had  continued  for  some 
time,  and  had  completely  prostrated  her  ; she  was  deadly  pale  ; lips 
blanched  ; pulse  scarcely  perceptible  ; and  every  evidence  present, 
that  the  hemorrhage  was  not  continuing  from  activity  of  vessels  ; or, 
at  all  events,  that  the  idea  of  activity  must  be  laid  aside  in  the  treat- 
ment, and  the  powers  of  life  be  supported,  or  otherwise  she  would 
sink.  The  uterus  was  in  an  uniropregnated  state.  The  usual  means 
with  the  tampon  were  adopted  successfully,  so  far  as  regarded  the 
immediate  flow  and  atonic  system  of  medication  was  recommended, 
under  which  the  hemorrhage  did  not  recur  during  the  day.  In  the 
evening,  the  family  physician  arrived,  who  finding  her  in  a comfort- 
able situation,  and  evidently  improving,  discontinued  the  tonics, 
under  the  apprehension,  from  the  knowledge  of  her  sanguine  tem- 
perament, that  violent  reaction  and  consequent  mischief  might  ensue; 
but  in  the  night  he  was  called  up,  owing  to  the  alarming  recurrence 


MODIFIED  BY  IDIOSYNCRASY. 


47 


of  the  hemorrhage,  and  was  glad  to  have  recourse  to  the  manage- 
ment, which  had  previously  proved  successful ; under  which  she 
ultimately  recovered,  and  since  that  period  — twenty  years  ago  — 
has  had  no  return  of  the  disease.  In  this  case,  a ‘‘  knowledge  of  the 
constitution”  was  likely  to  have  been  attended  with  disastrous  results. 
The  diseased  condition  is,  indeed,  the  only  point  to  which  attention 
has  to  be  directed  ; and  it  is  the  only  one  that  can,  in  general,  fall 
under  the  personal  observation  of  the  physician,  in  the  mode  in  which 
the  profession  is  regulated  in  England.  The  apothecary  is  there  the 
family  practitioner,  and  the  physician  is  only  called  in  consultation, 
so  that  the  chief  part  of  his  practice  must  necessarily  occur  in  per- 
sons, with  whose  constitutions  he  has  had  no  opportunity  of  being 
previously  acquainted. 

Temperament  is  conformation,  but  Idiosyncrasy — or  the  peculiar 
disposition  which  causes  an  individual  to  be  affected  by  extraneous 
bodies,  in  a way  in  which  mankind  in  general  are  not  acted  upon  by 
the  same  agents  — may  be  acquired,  and  when  once  it  has  been  so, 
it  is  apt  to  continue,  and  frequently  does  so,  throughout  the  whole  of 
existence.  The  author  possesses  a singular  idiosyncrasy  of  this  kind. 
If  a piece  of  thin  biscuit,  or  oaten-cake,  be  broken  in  his  presence,  — 
nay,  the  idea  alone  is  sufficient,  — the  muscles,  that  raise  the  left 
angle  of  the  mouth,  contract  irresistibly.  It  is  obviously  of  moment, 
that  the  practitioner  should  be  acquainted  with  all  idiosyncrasies  or 
peculiarities,  and  so  far  the  notion  of ‘‘knowing  the  constitution,”  — 
which  is  apt  to  be  used  to  the  prejudice  of  the  young  practitioner,  or 
of  any  except  the  accustomed  medical  attendant  — carries  reason 
with  it.  But  it  is  the  duty  of  the  patient  to  put  the  practitioner  in 
possession  of  the  fact  of  such  peculiarity,  so  that  he  may  be  enabled 
to  guard  against  it,  and  not  take  that  for  morbid,  which  is  the  effect 
of  simple  idiosyncrasy. 

By  virtue  of  these  peculiarities  medicines  will  often  produce  effects 
diametrically  opposite  to  those  they  ordinarily  exert.  The  author 
knows  a gentleman,  whom  opium  purges,  yet  this  drug  is  usually 
administered  to  check  inordinate  action  of  the  intestinal  tube.  Mr. 
Chevalier  gives  the  case  of  a lady,  who  could  not  take  powdered 
rhubarb  without  an  erysipelatous  efflorescence  showing  itself,  almost 
immediately  afterwards,  on  the  skin;  yet,  what  is  singular,  she  could 
take  it  in  the  form  of  infusion  with  perfect  impunity.  It  is  impossible 
for  the  physician  to  detect  these  peculiarities  by  any  signs.  His  in- 
formation has  to  be  wholly  derived  from  the  patient.  But  when 
once  acquired  he  is  expected  to  retain  it;  and,  strange  as  it  may 
seem,  all  confidence  in  the  practitioner  is  at  times  annihilated,  be- 
cause he  did  not  recollect  that  oil  of  peppermint,  or  some  other  trivial 
agent,  was  in  the  habit  of  disagreeing  with  his  patient.  It  is  apt  to 
be  regarded  as  an  evidence  that  he  did  not  attend  sufficiently  to  the 
constitution,  and  the  inference  is  drawn,  that  without  this,  his  en- 
deavours could  not  have  secured  the  full  amount  of  success,  whilst 


48 


THERAPEUTICAL  INDICATIONS 


his  inattention  might  have  been  productive  of  bad  effects,  owing  to 
the  irritation  that  might  have  been  induced,  by  the  development  of 
this  sympathy,  in  a frame  perhaps  already  too  much  disturbed  by 
morbid  influences. 

There  are  very  few  functions  of  the  body  that  are  altogether  free 
from  idiosyncrasies.  An  acquaintance  of  the  author  cannot  be  present 
where  ipecacuanha  is  being  powdered,  without  the  most  violent 
catarrhal  and  asthmatic  symptoms  being  produced;  and  many  similar 
cases  are  recorded.  The  smell  of  the  callicanthus  is  so  disagreeable 
to  another  as  to  be  almost  intolerable.  Pope  Pius  VI.  had  such  an 
antipathy  to  musk,  that  on  an  occasion  of  presentation,  an  individual 
of  the  company  having  been  scented  with  it,  his  holiness  was  obliged 
to  dismiss  the  party  almost  instantaneously.  These  are  idiosyncrasies 
or  peculiarities  connected  with  smells,  which  are  agreeable  to  the 
generality  of  mankind.  On  the  other  hand,  by  some,  offensive  smells 
are  preferred.  The  author  knew  a lady,  who  always  perfumed  her 
snuff  with  assafoetida;  and  Louis  XIV.  is  said  to  have  preferred  the 
smell  of  the  urine  of  the  cat  to  that  of  the  rose.  Some  persons, 
again,  cannot  take  peppermint,  and  wdth  many,  opium  disagrees, 
producing  the  most  intolerable  headache,  nausea,  and  vomiting,  and 
exciting  no  anodyne  effect  whatever.  Dr.  Thomson  refers  to  the 
case  of  an  individual,  who  was  always  attacked  with  syncope  when 
he  took  the  smallest  dose  of  calomel.  But  peculiarities  of  this  kind 
are  innumerable,  and  the  practitioner  ought  to  be  put  in  possession 
of  them,  otherwise  disagreeable  results  may  take  place ; the  economy 
may  be  disordered,  or  effects,  opposite  to  those  which  the  article 
usually  induces,  may  follow.  Several  such  peculiarities  are  referred 
to  in  the  author’s  Human  Physiology, 

The  different  impressibility  of  the  nervous  system  in  different  indi- 
viduals is  often  exemplified  in  practice  in  the  effect  produced  upon 
the  circulation  at  the  appearance  of  the  physician.  The  pulse  of  a 
delicate  female,  under  such  circumstances,  is  often  quickened  20  or 
30  beats  in  the  minute;  — a fact  which  the  physician  should  bear  in 
mind,  or  he  might  ascribe  that  to  disease,  which  is  the  mere  effect  of 
idiosyncrasy,  or  inordinate  impressibility.  In  some  persons,  the  pulse 
is  unusually  slow.  The  ordinary  number  of  beats  of  Napoleon’s  was 
44  in  the  minute;  the  author  knew  one  36;  and  Lizzari  refers  to  one, 
which  did  not  number  more  than  10:  but  it  is  possible^  that  in  this 
case  there  might  have  been  intermediate  beats  unperceived  by  the 
physician.  On  the  other  hand,  some  individuals  have  the  pulse 
much  quicker  than  ordinary.  Seventy  beats  in  the  minute  is  about 
the  average  in  the  healthy  male  ; but  sometimes  the  number  in  health 
is  as  high  as  90  or  100.  The  pulse  of  the  aged  is  generally  more 
frequent  than  that  of  the  adult,  and  is  irregular,  or  intermittent,  but 
it  is  occasionally  unusually  frequent  and  regular.  A change  of  this 
kind  occurred  to  a valued  friend  of  the  author,  who  had  filled  the 
highest  office  in  the  gift  of  his  countrymen.  Until  about  the  age  of 
80,  his  pulse  possessed  the  usual  character  appertaining  to  that  of 


MODIFIED  BY  IDIOSYNCRASY. 


49 


the  aged  ; but,  for  some  years  before  his  death,  it  became  quicker, 
beating  nearly  90  in  the  minute,  and  more  regularly  than  it  had  done. 
During  early  childhood,  the  same  intermittent  and  irregular  character 
exists  in  health,  but  the  pulse  is  faster  than  in  the  adult.  As  a 
general  rule,  at  birth  the  number  of  pulsations  is  from  130  to  140; 
at  one  year,  120;  at  two  years,  110;  at  three  years,  90  and  upwards; 
at  puberty,  80;  at  the  adult  age,  70;  and  in  old  age,  something  higher. 
In  the  female,  the  pulse  is  on  the  average  from  5 to  10  beats  quicker 
than  in  the  male. 

All  these  circumstances  have  of  course  to  be  borne  in  mind  in  in- 
vestigating any  case  of  disease.  But  owing  to  individual  peculiari- 
ties it  becomes  at  times  extremely  difficult  to  pronounce  upon  the 
existence  of  a morbid  condition  from  single  symptoms,  — as  from 
the  pulse,  more  especially  from  its  degree  of  quickness  or  slowness, 
inasmuch  as  we  are  not  always  acquainted  with  the  number  of  beats 
in  the  state  of  health.  It  is  partly  on  this  account,  that  Celsus 
termed  it  res  fallacissimaj"’^  yet,  it  has  even  been  made  the  ground 
of  discrimination  in  a case  of  suspected  insanity,  and  by  an  illus- 
trious native  of  this  country,  whose  eminent  abilities  were  at 
times  obscured  by  his  unbounded  enthusiasm,  and  too  prolific  imagi- 
nation. In  counterfeited  insanity.  Dr.  Rush  remarks,  the  pulse  will  be 
natural ; in  real  insanity  — as  has  been  since  established  by  observers  — 
it  is  generally  more  excited  than  in  a state  of  health  ; and  this  diag- 
nostic Dr.  Cooper  has  introduced  into  his  collection  of  Tracts  on 
Medical  Jurisprudence,'^'’  as  a fixed  and  invariable  law  ; to  which,  at 
least,  he  has  not  attached  any  doubt  or  exception.  “ The  know- 
ledge of  this  fact,”  adds  Dr.  Rush,  ‘‘has  once  been  applied  with 
success  in  the  administration  of  the  criminal  laws  of  the  United 
States.  One  of  the  two  men  who  were  condemned  to  die  for  trea- 
son, committed  against  the  general  government  in  the  western  coun- 
ties of  Pennsylvania  in  the  year  1794,  was  said  to  have  lost  his 
reason  after  sentence  of  death  had  been  pronounced  upon  him.  A 
physician  was  consulted  upon  his  case,  who  declared  his  madness 
to  be  feigned.  General  Washington,  then  President  of  the  United 
States,  directed  a consultation  of  physicians  upon  his  case.  Dr. 
Shippen,  Dr.  Samuel  P.  Griffitts,  and  myself  were  appointed  for  that 
purpose.  The  man  spoke  coherently  upon  several  subjects  ; and  for 
a while  the  state  of  his  mind  appeared  doubtful.  I suggested  the 
propriety  of  examining  his  pulse  : it  was  more  frequent  by  twenty 
strokes  in  a minute,  than  in  the  healthy  state  of  the  body  and  mind. 
Dr.  Shippen  ascribed  this  to  fear.  I then  requested  that  the  pulse 
of  his  companion  in  guilt  and  fear  might  be  felt.  It  was  perfectly 
natural  in  frequency  and  force.  This  discovery  induced  us  to  unite 
in  a certificate,  that  the  man,  who  was  only  supposed  to  be  mad, 
was  really  so  ; in  consequence  of  which  his  execution,  as  well  as 
that  of  his  companion,  were  suspended  for  two  months ; in  which 
time  the  popular  clamor  for  their  lives  so  far  subsided,  that  they 
VOL.  I. -—5 


50 


THERAPEUTICAL  INDICATIONS 


were  both  pardoned  by  the  executive  of  the  United  States.”  This 
is  perhaps  the  ne  plus  ultra  of  medical  philanthropy,  — rather  than 
of  science. 

From  all  tliat  has  been  said,  it  is  manifest,  that  idiosyncrasy  must 
have  much  power  in  modifying  the  operation  of  medicines  ; and 
that  it  is  consequently  important  for  the  practitioner  to  be  aware  of 
this  ; and  it  may  not  be  amiss  for  him  to  make  specific  inquiries, 
where  he  wishes  to  administer  such  drugs  as  are  apt  to  disagree 
with  certain  individuals,  — of  which  opium  and  its  preparations,  and 
calomel,  are  perhaps  the  most  prominent. 

4.  HABIT. 

By  this  is  understood  an  acquired  disposition  in  the  living  body, 
become  permanent,  and  as  imperious  as  any  of  those  primitive  acts, 
which  have  been  also,  in  another  sense,  denominated  habits.  When 
a function  is  over  and^over  again  exerted  to  the  utmost  extent  of 
which  it  is  capable,  both  as  regards  energy,  and  activity,  or  is  ex- 
erted beyond  the  ordinary  extent,  it  becomes  more  and  more  easy  of 
execution  ; the  organ  is  better  adapted  for  its  production  ; and,  it 
may  become  so  habituated  to  this  over-exertion,  that  a real  want  may 
be  engendered, — a ^‘second  nature,”  — and  the  individual  may 
feel  uncomfortable,  unless  the  organ  is  subjected  to  the  accustomed 
action.  In  the  same  way,  by  habit,  the  action  of  an  organ  may  be 
diminished,  until  ultimately  it  is  but  little  adapted  for  full  power. 
The  knowledge  of  these  facts  has  led  one  of  the  most  gifted  and  in- 
genious naturalists  of  the  present  age  — M.  De  Lamarck  — to  affirm, 
that  the  habits  of  an  animal  are  not  dependent  upon  its  organisa- 
tion ; but  that,  on  the  contrary,  its  habits,  mode  of  life,  and  those 
of  its  ancestors  have,  in  the  succession  of  ages,  determined  the  form 
of  its  body,  the  number  and  condition  of  its  organs,  and  the  func- 
tions and  the  faculties  it  enjoys:  — a position,  which  he  has  sup- 
ported with  much  plausibility,  and  at  the  same  time  with  much  that 
approximates  to  the  reductio  ad  absurdum:  for  example,  where 
he  takes  the  case  of  reptiles,  which,  as  well  as  other  vertebrated 
animals,  in  his  view,  had  originally,  according  to  the  great  plan  of 
organisation,  four  paws  attached  to  the  trunk.  Serpents  must  con- 
sequently have  had  four  ; but  having  assumed  the  habit  of  creeping 
along  the  ground,  and  of  concealing  themselves  in  the  grass,  their 
bodies,  owing  to  perpetual  efforts  at  elongation,  to  enable  them  to 
pass  into  narrow  spaces,  acquired  an  unusual  length  in  no  wise  pro- 
portionate to  their  thickness.  Paws  would  have  been  quite  useless. 
Long  paws  would  have  interfered  with  their  creeping,  and  very  short 
paws  would  have  been  but  ill  adapted  for  moving  the  body.  Hence, 
the  want  of  employment  of  these  parts  being  constant,  they  gra- 
dually disappeared;  although,  says  De  Lamarck,  they  may  have 
originally  entered  into  the  plan  of  organisation  of  animals  of  their 
class. 

But,  although  this  distinguished  naturalist  carries  the  effect  of 
function  on  organisation  to  an  extent,  which  cannot  be  main- 


MODIFIED  BY  HABIT. 


51 


tained  ; it  is  certain,  that  the  habitual  exercise  of  an  organ  does  add 
to  its  development,  within  certain  limits,  whilst  inaction  gives  occa- 
sion to  its  impoverishment.  We  have  this  signally  exemplified,  if 
we  restrict  an  animal  to  diet  of  a different  character  from  that  to 
which  it  has  been  accustomed  ; or  to  one  foreign  to  its  nature.  In 
birds  of  prey,  the  digastric  muscle  — which  is  strong  in  the  gallina- 
ceous bird  — has  the  bellies  composing  it  so  weak,  that,  according  to 
Sir  Everard  Home,  nothing  but  an  accurate  examination  can  deter- 
mine its  existence.  But  if  a bird  of  this  kind,  from  want  of  animal 
food,  be  compelled  to  live  upon  grain,  the  bellies  of  the  muscle 
become  so  large,  that  they  would  not  be  recognised  as  belonging 
to  the  stomach  of  a bird  of  prey.  Mr.  Hunter  kept  a sea  gull  for  a 
year  upon  grain  ; after  which  he  found  the  strength  of  the  muscle 
greatly  augmented.  This  wondrous  adaptation  of  structure  to  the 
kind  of  food,  which  the  animal  is  capable  of  obtaining,  is  likewise 
elucidated  in  the  case  of  the  South  American,  and  of  the  African 
ostrich.  The  former  is  the  native  of  a more  productive  soil  than  the 
latter,  and  accordingly  the  gastric  glands  are  less  complex,  and 
numerous,  and  the  triturating  organ  is  less  developed.  It  is  owing 
to  the  effect  upon  the  body  of  long-continued  action,  that  old  and 
inveterate  habits  cannot  be  suddenly  broken  in  upon  with  impunity. 
Hence,  issues,  or  other  discharges  must  be  gradually  checked  prior 
to  total  occlusion  ; otherwise,  the  irritation,  and  consequent  afflux, 
may  be  directed  to  other  and  important  organs,  which  may  be,  at  the 
time,  disposed  to  assume  a morbid  action. 

In  like  manner,  where  a person  has  been  in  the  habit  of  daily  in- 
dulging in  the  unmeasured  use  of  spirituous  liquors  or  of  opium,  we 
cannot  safely  withdraw,  at  once,*  the  accustomed  stimulus.  The  ner- 
vous system,  habituated  to  stimulation,  totters,  if  the  excitants  be 
withdrawn ; and  delirium  tremens,  with  all  its  horrors,  almost  surely 
supervenes.  In  times  of  spreading  sickness,  such  sudden  and  total 
change  of  inveterate  habits  adds,  no  doubt,  greatly  to  the  extent  of 
the  calamity.  The  drunkard  becomes  alarmed  ; abandons  his  stimu- 
lant; and,  under  the  depression  that  follows,  readily  imbibes  the 
morbific  influence,  and  sinks  a victim  to  incautious  reformation. 

The  effect  of  medicines  on  the  frame  is  much  influenced  by  habit. 
As  a general  rule,  continued  use  detracts  from  their  power.  This  is 
strongly  shown  in  the  case  of  opium.  Instances  are  related,  in  which 
two  drachms,  or  one  hundred  and  twenty  grains  of  solid  opium,  or 
five  fluid  ounces  of  laudanum,  have  been  taken  in  twenty-four  hours  ; 
yet  before  the  habit  was  induced  these  persons  could  not  have  taken 
as  many  grains  without  danger.  But  although  this  habit  of  endurance 
or  resistance  has  been  acquired  in  the  case  of  opium,  it  does  not  fol- 
low that  the  system,  thus  rendered  obdurate  to  it,  will  resist  large 
doses  of  other  narcotics.  Notwithstanding  these  extraordinary 
quantities  of  opium  may  be  swallowed  with  impunity,  the  same  in- 
dividual may  be  affected  with  considerable  facility,  provided  another 
narcotic  be  substituted.  In  like  manner,  if  a person  has  been  habit- 


52 


THERAPEUTICAL  INDICATIONS 


uated  to  the  use  of  aloes  as  a cathartic,  it  may  altogether  lose  its 
effect ; yet  if  we  change  the  special  irritant,  or  have  recourse  to  ano- 
ther cathartic  — castor  oil,  or  sulphate  of  magnesia,  for  example  — 
catharsis  may  be  produced  by  an  ordinary  dose.  It  does  not  there- 
fore follow,  that  the  sensibility  of  the  mucous  membrane  of  the  intes- 
tinal canal  becomes  blunted  in  these  cases.  It  merely  loses  its 
impressibility  as  regards  one  irritant ; w’hilst  it  may  be  equally  sus- 
ceptible of  irritation  from  every  other  irritant  of  the  class. 

According  to  this  general  effect  of  habit,  it  would  follow,  that  the 
second  dose  of  a cathartic  ought  to  be  larger  than  the  first,  provided 
it  be  administered  within  such  a period,  that  the  influence  of  the  first 
dose  continues  to  be  felt ; and  it  is  the  usual  practice  with  the  phy- 
sician to  direct  the  after  dose  to  be  larger : but  there  are  some 
cathartics,  which  appear  to  differ  in  their  action  upon  the  mucous 
surface  so  as  to  render  it  more  impressible,  — many  of  the  salines, 
for  example.  This  effect  has  long  been  ascribed  to  the  Cheltenham 
water.  It  would  seem,  too,  that  the  constitution,  so  far  from  be- 
coming reconciled  to  lead  by  habit,  is  rendered  more  and  more  sen- 
sible to  its  irritation.  Emetics  also  frequently  act  more  powerfully 
by  repetition.  Dr.  Cullen  affirms,  that  he  knew  a person  so  accus- 
tomed to  excite  vomiting  on  himself,  that  the  one-twentieth  part  of 
a grain  of  the  tartrate  of  antimony  and  potassa  was  sufficient  to  pro- 
duce a convulsive  action  of  the  parts  concerned  in  vomiting.  This 
difference  as  to  the  effects  of  agents  by  repetition  we  observe  in 
disease.  In  certain  cases,  after  the  system  has  been  once  morbidly 
impressed,  it  is  ever  afterwards  unsusceptible  of  the  same  mischief ; 
in  others,  it  is  less  susceptible  ; whilst  in  others  again  it  is  rendered 
unusually  impressible.  The  last  effect  is  signally  observable  in  the 
case  of  miasmata  — those  at  least  which  give  rise  to  intermittent 
fever.  A person,  who  has  once  suffered  under  a pernicious,  or 
severe,  or  even  ordinary  intermittent,  may  require  a less  dose  of  the 
malaria  to  reproduce  the  disease,  than  was  required  to  occasion  the 
first  attack  ; and,  at  times,  the  nervous  system  becomes  so  impressible, 
that  a chill  is  experienced  whenever  the  individual  enters  upon  a 
soil  which  is  exhaliug  the  miasm.  Persons  so  extraordinarily  im- 
pressible have,  indeed,  been  used  to  indicate  the  existence  or  non- 
existence of  malarious  exhalations  in  given  localities.  In  the  seventy- 
second  number  of  the  “ Edinburgh  Review,”  a writer  pronounces 
several  districts  surrounding  St.  James’  Park,  in  London,  to  be 
unhealthy,  owing  to  such  exhalations,  as  tested  in  the  mode  just 
mentioned;  — an  officer  who  had  suffered  at  Walcheren  being  the 
miasm  ometer  ! 

It  may  be  laid  down  then,  as  a general  rule,  that  remedies  lose 
their  effect  by  habit ; and  this  is  often  strikingly  the  case  with  tonics  ; 
yet  if  another  tonic  be  substituted  for  a day  or  two,  and  the  former 
be  afterwards  resumed,  it  will  produce  all  its  previous  effects. 
Although,  however,  this  is  the  general  rule,  it  admits  of  numerous 
exceptions. 


MODIFIED  BY  CLIMATE. 


53 


L CLIMATE. 

The  capability  of  existing  in  all  climates  is  one  of  the  attributes  of 
humanity.  Man  is  however  considerably  modified  in  his  physical 
and  mental  characteristics  by  situation.  The  temperate  zone  appears 
to  be  best  adapted  for  his  full  development ; and  it  is  there  that  the 
greatest  ornaments  of  mankind  have  existed,  and  that  science  and 
art  have  flourished  in  exuberance  ; whilst  in  the  torrid  regions,  the 
sensibility  is  over-excited  ; physical  and  moral  energy  is  obtunded  ; 
and  the  native  of  the  temperate  zone,  who  has  entered  them  full  of 
life  and  buoyancy,  has  quitted  them,  after  a few  years’  residence, 
listless,  and  shorn  of  his  proudest  characteristics.  The  frigid  zone, 
on  the  other  hand,  is  equally  unfavourable  to  mental,  and  corporeal 
development ; the  sensibility  being  blunted  by  the  rigors  of  the  cli- 
mate. But  the  effect  of  locality  is  perhaps  most  signally  exemplified 
in  the  cretm  and  goitreux  of  the  Valais,  and  of  situations  at  the  base 
of  lofty  mountains  in  almost  every  part  of  the  globe  ; as  well  as  in 
the  inhabitants  of  our  low  countries,  who  are  constantly  exposed  to 
malarious  exhalations,  and  bear  the  sallow  imprint  on  their  counte- 
nances. The  whole  of  the  circumstances  connected  with  the  causa- 
tion of  endemic  disease  exhibit  the  powerful  influence  of  locality  in 
the  way  of  morbid  impressions  ; and  the  outward  conformation  of  the 
natives  of  different  countries  is  an  equal  exemplification  of  its  physio- 
logical influence.  It  is  owing  to  such  climatic  modification,  that  we 
are  enabled  to  distinguish  the  Frenchman  from  the  Spaniard,  Italian 
and  Portuguese,  although  belonging  originally  to  the  same  great  Ro- 
manic stem  ; as  well  as  to  discriminate  the  different  branches  of  the 
Teutonic  race  — the  German,  Dutch,  and  the  Scandinavian  — from 
each  other. 

As  regards  the  disposition  to  disease  of  particular  organs,  induced 
by  climate,  it  may  be  laid  down  as  a general  truth,  that  hot  climates 
dispose  to  bilious  complications.  The  heat  occasions  erethism  in 
the  whole  dermoid  system;  — hence  diarrhoea,  dysentery,  cholera 
morbus,  &c.,  dependent  upon  irritation  or  inflammation  of  the  lining 
membrane  of  the  intestines  ; and  this  irritation,  being  propagated  by 
continuous  sympathy  along  the  biliary  duct  to  the  liver,  that  organ  is 
excited,  sometimes  inflamed,  and  in  this  way  disease  of  the  liver 
becomes  induced  by  the  influence  of  heat.  The  mode  adopted  at 
Strasburg  and  Metz,  for  enlarging  the  liver  of  the  goose,  is  signally 
elucidative  of  this  subject.  (See  the  author’s  Human  Healthy  p.  27, 
Philad.  1844.)  On  the  other  hand,  in  cold  climates,  there  is  a greater 
tendency  to  inflammation  of  the  mucous  membrane  of  the  air  pas- 
sages ; — the  irregularity  in  the  cutaneous  and  pulmonary  transpira- 
tions giving  occasion  to  local  excitement  in  the  bronchial  mucous 
membrane,  which  is  not  always  restricted  to  that  texture,  but  in 
favouring  habits  may  extend  to  the  substance  of  the  lungs,  so  as  to 
develope  pulmonary  consumption.  Hence,  the  effects  of  change  of 
climate  — especially  the  removal  from  a temperate  to  a torrid  region, 
5^ 


54 


THERAPEUTICAL  INDICATIONS 


or  conversely  — become  an  interesting  topic  of  inquiry  to  the  physi- 
cian in  a hygienical  as  well  as  therapeutical  point  of  view.  The 
author  has  elsewhere  shown,  that  owing  to  the  great  nervous  suscep- 
tibility induced  by  the  heat  of  the  warmer  climes,  such  climes  are  unfit 
for  those  that  are  predisposed  to  mania,  and  to  head  affections  in 
general ; whilst  they  are,  cceteris  paribus^  the  best  that  could  be  se- 
lected for  such  as  are  predisposed  to  pulmonary  consumption,  although 
most  fatal  to  the  same  class  of  patients  when  the  consumption  has 
become  confirmed. 

The  circumstances,  that  modify  the  physiological  and  pathological 
condition  of  man,  necessarily  modify  also  the  mode  of  fulfilling 
therapeutical  indications  which  might  seem  to  be  obvious.  The 
well-instructed  physician  readily  detects  those  differences,  otherwise 
it  would  be  necessary,  that  every  student  should  receive  his  educa- 
tion in  the  country  where  he  has  to  practise  his  profession.  The 
practitioners,  who  are  destined  to  exercise  their  calling  in  British 
India,  receive  their  education  in  the  mother  country,  whilst  Phila- 
delphia sends  her  alumni  to  practise  in  Maine,  in  Louisiana,  and 
indeed  in  every  part  of  the  globe  to  which  the  interest  of  the  nation, 
or  the  thirst  of  gain  leads  the  hardy  and  venturous  citizen.  The 
principles  of  the  science  — as  before  remarked — are  alike  every 
where,  and  but  slight  observation  is  requisite  to  guide  the  properly  in- 
structed mind  to  the  appreciation  of  climatic  differences  of  every  kind. 

Climate  has  some  influence,  but  not  a great  deal,  in  modifying  the 
action  of  remedies.  Dr.  Harrison  found,  that  narcotics  produced 
more  effect  in  Naples,  than  in  England.  He  instances  the  extract  of 
hyoscyamus,  which,  in  doses  of  three  grains,  three  times  a day,  at 
Naples,  produced  temporary  amaurosis  or  nervous  blindness,  which 
disappeared  and  recurred  on  the  alternate  suspension  and  adminis- 
tration of  the  medicine.  This  was  observed  in  two  patients,  who 
had  often  taken  similar  doses  of  the  same  remedy,  in  England  with- 
out any  unpleasant  result,  — an  eflfect  which  Dr.  Harrison  refers  to 
the  increased  nervous  susceptibility  or  impressibility  induced  by  the 
warmer  climate.  It  might  be  imagined,  that  a source  of  fallacy  ex- 
isted in  the  circumstance  of  the  Italian  extract  being  more  powerful 
than  the  English  ; but  in  answer  to  this.  Dr.  Harrison  remarks,  that 
the  medicine,  which  he  administered  in  Italy,  was  procured  from 
London.  The  same  gentleman  found,  moreover,  as  a general  rule, 
that  the  doses  of  medicines,  as  ordered  in  England,  were  too  large 
for  the  climate  of  Italy.  The  rule  indeed  may  be  extended,  and  it 
may  be  laid  down,  that  remedies  act  more  powerfully,  or  produce 
the  same  effect  in  smaller  doses  in  hot  climates,  owing  to  the  greater 
nervous  susceptibility  of  the  residents  in  such  climates.  Still,  to  this 
there  are  numerous  exceptions.  In  referring  to  the  subject.  Dr. 
Thomson  remarks,  that  “ it  does  not  always  follow,  that  the  doses  of 
medicine  require  to  be  reduced  in  warm  climates ; on  the  contrary, 
in  India,  a scruple  of  calomel  and  a grain  of  opium  are  frequently 
administered,  and  repeated  at  short  intervals,  after  depletion  in  dy- 


MODIFIED  BY  CLIMATE. 


55 


sentery  and  he  adds,  — what  must  amuse  the  residents  of  many 
of  the  malarious  districts  of  this  country,  and  especially  of  the  valley 
of  the  Mississippi,  — that  “ but  few  physicians  would  venture  to  pre- 
scribe this  active  remedy,  in  such  large  doses  in  this  climate,”  — in 
other  words,  in  temperate  climates.  The  truth  is,  that  the  action  of 
calomel  is  but  imperfectly  understood.  The  French  speak  with  hor- 
ror of  the  doses  administered  by  the  English ; and  in  some  parts  of 
this  country  they  are  equally  surprised  at  the  small  doses  in  which  it 
is  employed  in  England.  The  author  well  recollects  the  tone  in 
which  a distinguished  French  army  physician  spoke  of  the  hardihood 
of  the  English  physicians  in  prescribing  three  grain  doses  of  calomel ; 
yet  there  are  practitioners  in  this  country,  who  give  it  in  the  dose  of 
one  hundred,  or  one  hundred  and  fifty  grains,  and  even  more.  These 
immense  doses  do  not  produce  a purgative  effect  in  a direct  ratio 
with  the  dose.  On  the  contrary,  two  or  three  grains  may  be  actively 
cathartic,  whilst  twenty  may  not  produce  more  or  as  much  effect. 
After  bleeding  especially,  absorption  is  active  ; the  calomel  speedily 
attains  the  circulation,  and  is  given  off  by  the  cutaneous  exhalants, 
as  is  evidenced  by  the  effect  produced  upon  a gold  watch  worn  by 
the  patient.  Such  appears  to  be  the  effect  of  a very  large  dose,  even 
when  blood-letting  has  not  been  premised,  whilst  a small  dose  irri- 
tates — without  there  being  the  stimulus  of  quantity  to  induce  its 
absorption  — and  has  a cathartic  agency.  In  this  way,  a large  dose 
of  calomel  may  defeat  the  object  of  the  prescriber  if  he  wishes  to 
produce  catharsis,  and  by  undergoing  absorption  and  coming  in  con- 
tact with  every  organ,  it  may  excite  a new  action  in  the  whole  se- 
cretory system  ; and  even  if  we  admit,  that  when  given  in  unusual 
quantity,  it  is  altogether  harmless,  the  superfluous  amount  must  be  a 
waste  of  the  article. 

In  all  the  cases  in  which  such  large  doses  of  calomel  are  adminis- 
tered, the  practitioner  is  led  to  persuade  himself,  that  the  climate 
requires  them.  But  this  argument  is  often  fallacious,  and  it  may  be 
employed  to  bolster  up  any  plan,  that  has  received  the  approbation 
of  a part  or  of  most  of  the  profession,  too  often,  perhaps,  without  suf- 
ficient examination.  Not  many  years  ago,  in  the  fevers  of  the  South 
and  West,  calomel  was  considered  to  be  indispensable.  Now,  it  is 
affirmed  by  many  to  be  unnecessary,  and  often  injurious,  whilst  the 
sulphate  of  quinia  is  looked  upon  as  the  remedy  par  excellence.  It 
has  been  a common  opinion,  too,  that  in  our  ordinary  bilious  fevers, 
copious  blood-letting,  and  the  most  active  and  irritating  cathartics  are 
imperiously  demanded ; and  the  practice  founded  upon  this  belief 
was  at  one  time  universal;  so  much  so,  indeed,  that  no  other  was 
adopted  extensively  until  of  late  years  ; but  since  a greater  degree  of 
attention  has  been  paid  to  the  condition  of  the  mucous  membranes  in 
these  affections,  and  a better  philosophy  has  suggested,  that  whilst 
we  are  keeping  the  different  external  sensitive  surfaces  free  from  ail 
irritation,  we  ought  not  to  be  perpetually  irritating  the  internal  der- 
moid prolongation,  practitioners  have  been  induced  to  abandon  the 


56 


THERAPEUTICAL  INDICATIONS 


constant  use  of  irritating  cathartics;  to  keep  the  digestive  canal  free 
by  the  use  of  mild  cathartics,  which  remove  the  morbid  secretions  as 
they  are  formed;  and,  by  the  proper  use  of  sedatives  — of  which 
blood-letting  is  almost  the  only  one — and  of  refrigerants,  to  reduce 
the  inflammatory  excitement.  By  such  a plan — and  experience  can 
equally  be  adduced  in  its  support  — the  ordinary  bilious  fevers  of  our 
country  will  be  found  to  yield  more  satisfactorily,  than  under  the 
mixed  sedative  and  irritating  treatment,  which  was  formerly  uni- 
versal, and  still  prevails  too  extensively.  It  is  obvious,  too,  that 
where  one  system  of  medication  is  exclusively  employed,  it  is  im- 
possible to  draw  any  deductions  from  comparison,  and  we  are  not 
Justified  in  affirming,  that  climate  requires  one  system  more  than 
another  until  an  equal  trial  has  been  made  of  all. 

The  therapeutist  has  opportunities  for  witnessing  the  modifying 
influence  of  climate,  when  individuals  pass  from  a torrid  to  a tempe- 
rate or  frigid  region,  and  conversely.  If  the  removal  has  been  from  a 
hot  to  a cold  climate,  the  impressibility  is  diminished,  and  larger 
doses  of  medicines  are  necessary  to  produce  the  wonted  eflect ; if 
from  a cold  to  a hot,  the  impressibility  is  augmented  ; smaller  doses 
are  necessary  ; and,  owing  to  the  same  cause,  less  powerful  excitants 
produce  fever,  and  stimulating  drinks  have  to  be  carefully  avoided. 

With  respect  to  inuring  foreigners  to  a country,”  says  a modern 
writer  on  Therapeutics  — M.  Begin  — “we  are  to  preserve  their 
organs  against  the  impression  of  the  climate,  whose  influence  has 
been  studiously  examined.  Thus,  the  inhabitants  of  the  south,  when 
transplanted  into  cold  and  damp  climates,  should  keep  their  bodies 
warmly  clothed,  to  preserve  themselves  from  bronchitis  and  pneu- 
monia, to  which  they  become  much  exposed  : they  are  to  assume 
gradually  the  use  of  warm  and  somewhat  stimulating  drinks.  A 
substantial  diet,  consisting  of  animal  food,  with  the  moderate  use  of 
spirituous  liquors,  are  the  precepts  to  be  observed  in  passing  from  a 
warm  to  a colder  climate.  Complete  sobriety,  and  the  use  of  vege- 
getable  food,  are,  on  the  contrary,  necessary  for  those  who  pass  from 
a northern  to  a southern  latitude.  In  marshy  places,  abounding  in 
simple  or  pernicious  intermittents  : — in  those  climates  that  are  de- 
vastated by  plague,  yellow  fever,  cholera  morbus,  or  dysentery,  it  is 
necessary  to  shun  the  action  of  the  deleterious  miasmata,  to  approach 
only  by  degrees  foyers  of  infection,  to  avoid  intemperance  of  all 
kinds,  and  every  excess,  which,  by  increasing  their  susceptibility  and 
irritating  the  digestive  organs,  evidently  dispose  to  endemic  diseases.” 
These  last  recommendations  are  equally  applicable  where  the  change 
of  residence  has  been  from  a warmer  to  a colder  region,  even  where 
there  may  be  no  endemic  disease.  It  has  been  a matter  of  repeated 
observation,  that  the  habit,  acquired  during  a sojourn  of  some  dura- 
tion in  any  climate,  remains  for  some  time  after  a removal  to  one  of 
opposite  character.  Dr.  Edwards  has  shown  this  as  regards  the 
physiological  performance  of  certain  functions,  and  it  has  been  long 
noticed  pathologically  in  the  wateripg  and  other  places  of  Great 


MODIFIED  BY  MENTAL  AFFECTIONS. 


57 


Britain,  — the  resorts  of  the  healthy  and  the  valetudinarian  from  Bri- 
tish India.  Whatever  complaint  may  attack  the  stranger,  it  is  apt 
to  assume  the  intermittent  type,  the  foundation  of  which  has  been 
impressed  on  the  organism  by  previous  residence  in  a hot  and  mark- 
edly malarious  region.  In  such  cases,  too,  the  predisposition  to 
disease  of  those  textures,  in  which  erethism  exists  owing  to  great 
atmospheric  heat,  is  manifest.  It  is  in  individuals  thus  circumstanced, 
that  M.  Begin  recommends  the  tolerably  free  use  of  spirituous  liquors 
— a measure,  to  say  the  least  of  it,  doubtful,  and  in  the  author’s 
opinion,  more  likely  to  produce  irregularity  of  action,  than  any  regi- 
men that  could  be  advised,  — as  it  is  impossible  to  keep  up  the  ex- 
citation uniformly ; depression  must  therefore  succeed  to  the  stimu- 
lation, and  the  former  in  a degree  proportionate  to  the  extent  of  the 
latter.  In  such  a condition  morbific  agents  must  necessarily  impress 
the  economy  more  powerfully  than  if  all  had  been  regularity  in  place 
of  disorder. 

What  has  been  said  of  climate,  as  respects  temperature,  applies 
also  to  seasons.  During  the  summer,  the  tendency  of  diseased  ex- 
citement is  to  the  mucous  membrane  of  the  alimentary  canal;  during 
the  winter,  to  that  of  the  lungs.  The  summer  season  is  extremely 
fatal  to  infants  in  our  cities,  owing  to  a disease  which  consists  essen- 
tially in  inflammation  of  the  lining  membrane  of  the  tube,  and  is 
produced  apparently  by  the  combined  action  of  heat  and  deteriorated 
air.  The  former  alone  appears  to  be  insufficient  to  account  for  its 
prevalence,  as  it  is  rare  in  country  situations,  where  an  equal  ele- 
vation of  temperature  may  prevail ; and  one  of  the  most  certain  modes 
of  prevention  is  to  remove  the  infant  from  the  town  to  the  country. 

6.  MENTAL  AFFECTIONS. 

We  have  numerous  opportunities  for  observing  the  powerful  eflects 
induced  by  the  affective  faculties  on  the  different  functions  when  in  a 
state  of  health.  All  these  are  caused  by  sympathetic  association  with 
the  brain;  the  organ  secondarily  affected  being  in  a state  of  excitation 
or  depression  according  to  the  precise  character  of  the  emotion.  Of 
the  therapeutical  influence  of  different  emotions,  the  author  will  have 
to  treat  hereafter;  some  of  them  being  important  agenis  in  the  removal 
of  different  forms  of  disease.  The  effects  of  one  of  the  intellectual 
faculties,  when  inordinately  exerted,  on  the  bodily  functions,  are 
signal;  and  to  these  must  be  ascribed  cures,  that  are  said  to  have 
been  effected  by  modes  of  management  — often  of  the  most  revolting 
character  — from  time  to  time  in  vogue.  In  nervous,  delicate,  and 
imaginative  persons,  pains  can  be  felt  any  where : sometimes,  too, 
disease  is  developed  in  this  manner  ; and,  at  others,  feelings  as  dis- 
tressing as  if  they  resulted  from  actual  disease. 

It  is  through  the  imagination  and  its  influence  on  the  body,  that 
we  must  explain  the  effects  of  credulity  and  superstition,  so  long 
employed  as  therapeutical  agencies.  At  one  period  in  the  history 


58 


THERAPEUTICAL  INDICATIONS 


of  medical  science,  the  materia  medica  consisted  almost  wholly  of 
the  machinery  of  magic.  Some,  indeed,  as  Pliny,  affirm,  that  magic 
was  wholly  derived  from  medicine  ; but  without  inquiring  into  their 
precise  order  of  precedence,  it  is  certain,  that  there  was  a close 
affinity  between  them.  The  word  Ananazipta^  scrawled  on  parch- 
ment, was  said  to  cool  fever.  Abracadabra^  supposed  by  Selden  to 
be  the  name  of  a Syrian  idol,  figured  on  an  amulet,  and  worn  round 
the  neck,  was  supposed  to  possess  the  power  of  curing  ague,  and  of 
preventing  many  diseases,  especially  when  uttered  in  a certain  form, 
and  a certain  number  of  times.  An  hexameter  from  the  “ Iliad” 
allayed  the  agony  of  gout,  and  rheumatism  yielded  to  a verse  of  the 
‘‘Lamentations.”  In  all  these  cases,  the  effects  upon  the  physical 
ailment  may  have  been  produced  through  the  action  of  the  mind  on 
the  body,  of  which  we  have  so  many  marked  examples,  and  to  some 
of  which  reference  will  be  made  presently;  but,  in  other  cases,  the 
incantation  w'as  used,  where  such  agency  could  scarcely  be  presumed. 
Cato,  the  Censor,  for  example,  pretended  to  be  able  to  reduce  lux- 
ations, after  the  manner  of  the  Etruscans  and  Pythagoreans,  by  bar- 
barous expressions,  and  by  magical  songs;  — such  as  motas  vaeta 
daries  dardaries  astatutaries^'^"’  or  haul  huat  ista  pista  sista, 

domiabo  damnaustra  et  luxatoA  Homer,  too,  affirms,  that  the  bleed- 
ing of  the  wounded  Ulysses  was  stopped  by  a charm,  and  the  notion 
has  passed  down  to  the  present  enlightened  age,  and  prevails  in 
certain  parts  of  Great  Britain.  It  is  referred  to  by  Sir  Walter  Scott 
in  the  “ Lay  of  the  Last  Minstrel,”  and  is  noticed  frequently  in  the 
popular  poetry  of  the  last  century  but  one.  In  all  these  cases,  how- 
ever, it  is  probable  that  the  enchanter  employed  more  direct  appli- 
ances to  the  injured  part,  as  in  the  “ cure  by  sympathy,”  to  which 
reference  has  already  been  made,  and  that  he  had  not  therefore 
implicit  confidence  in  his  charms.  The  only  remnant  of  the  notion 
of  charms,  yet  retained  in  medical  language,  is  the  word  “ carmina- 
tive,” applied  to  a class  of  medicinal  substances,  employed  in  cases, 
which  were  usually  cured,  or  attempted  to  be  cured,  by  carmina  or  in- 
cantations in  verse,  or  to  such  as  operated  like  carmina  or  verse  charms. 

It  is  not  much  more  than  a hundred  years  since  the  doctrine  of 
curing  the  scrofula  or  king’s  evil  by  the  royal  touchy  or  wdiat  Browne 
affectedly  calls  Adenochirapsologia^  was  implicitly  credited,  and  not 
unfrequently  followed.  TThe  first  English  sovereign,  who  touched 
for  this  affection,  was  Edward,  the  Confessor,  who  lived  in  the  mid- 
dle of  the  eleventh  century,  and  the  last  that  encouraged  it,  w^as 
Queen  Anne,  who  died  about  the  commencement  of  the  last  century. 
One  of  the  very  last,  subjected  to  the  degrading  mummery,  was  the 
illustrious  Dr.  Samuel  Johnson,  who,  by  the  advice  of  a celebrated 
physician.  Sir  John  Floyer,  was  carried  to  London  in  1712,  where 
he  was  actually  touched  by  Queen  Anne,  but  without  effect.  Much 
of  the  success,  that  often  followed  this  practice,  has  been  ascribed  to 
the  influence  of  the  mind  over  the  body  ; but  Wiseman,  one  of  the 
fathers  of  surgery,  who  lived  in  the  early  part  of  the  seventeenth 


MODIFIED  BY  MENTAL  AFFECTIONS. 


59 


century,  and  who  had  the  best  opportunities  for  observation,  asserts, 
that  a part  of  the  duty  of  the  royal  physicians,  and  serjeant-surgeons 
was  to  select  such  patients,  afflicted  with  the  evil,  as  showed  a ten- 
dency towards  recovery, — rejecting  all  others  ; and  as  full  confidence 
was  placed  in  the  effects  of  the  royal  touch,  the  disease  was  fortu- 
nately left  to  itself,  and  not  officiously  interfered  with.  (For  some 
well  written  remarks  on  this  and  other  strange  fallacies,  see  two  lec- 
tures entitled  “ Homoeopathy  and  its  kindred  delusiors,  &e.”  By 
Oliver  Wendell  Holmes,  M.D.,  Boston,  1842.) 

It  would  be  as  impossible,  as  nnadvisable,  to  instance  the  various 
shapes,  which  superstition,  applied  to  medicine,  has  assumed  ; and 
the  hold,  which  it  has  taken  on  the  minds  of  many,  whose  station  in 
society,  and  whose  general  attainments,  it  might  have  been  presumed, 
would  have  steeled  them  against  the  intrusion  of  such  beliefs.  The 
science  of  medicine  has  suffered  largely  from  the  credulity  and  igno- 
rance of  those  who  profess  it,  and  nothing  can  exhibit  this  more 
strikingly  than  the  repulsive,  and  ridiculous  agents,  which  have  been 
had  recourse  to  as  a part  of  the  materia  medica ; some  of  which 
were  introduced  or  recommended  by  individuals,  distinguished  in 
their  day  for  superior  intelligence.  Thus,  Bacon  believed  in  the 
virtue  of  charms,  and  amulets  ; and  Boyle  thought  the  thigh  bone  of 
an  executed  criminal  a powerful  remedy  in  dysentery.  Celsus  ad- 
vised the  warm  blood  of  a recently  slain  gladiator,  or  a certain  por- 
tion of  human  or  horse  flesh,  for  the  cure  of  epilepsy  ; and  remedies 
of  this  description  are  said  to  have  been  actually  exhibited,  with 
success,  for  the  cure  of  epileptics,  in  the  poor-house  at  Haerlem,  by 
Abraham  Kaauw  Boerhaave,  nephew  to  the  celebrated  Hermann, 
and  professor  of  medicine  at  St.  Petersburg,  who  lived  so  recently 
as  the  middle  of  the  last  century.  Amongst  the  wspecifies  of  Alexander 
of  Tralles,  were — the  liver  of  a weasel  freed  from  bile,  taken  for 
three  successive  days,  fasting  ; the  skull  of  an  ass,  and  the  ashes  of 
clothes  stained  with  the  blood  of  gladiators.  Pliny  recommends 
stones,  taken  from  the  craws  of  young  swallows,  in  epilepsy.  De- 
mocritus mentions,  that  some  diseases  are  best  cured  by  anointing 
with  the  blood  of  strangers  and  malefactors,  and  others,  with  the 
blood  of  our  friends  and  kinsfolk.  Miletus  cured  affections  of  the 
eyes  with  human  bile.  Artemon  treated  epilepsy  with  dead  men’s 
skulls,  and  Antheus,  convulsions  with  human  brains. 

It  may  be  said,  that  most  of  these  degrading  examples  of  credulous 
ignorance  are  taken  from  a far  distant  age,  when  physical  science 
was  yet  in  its  infancy.  It  would  be  easy,  however,  to  show,  that, 
at  a much  later  period,  the  same  credulity  reigned  where  it  was  least 
to  be  expected  ; and  even  now  the  pharmacopoeias  of  certain  coun- 
tries, eminent  amongst  nations  for  the  advanced  condition  of  mind 
in  many  of  its  aspects,  exhibit  evidences  of  the  like  degradation. 
Sir  Theodore  Turquet  de  Mayerne  — who  was  physician  to  James 
the  First,  Charles  the  First,  and  Charles  the  Second,  of  England, 
and  who  was  the  most  distinguished  character  of  his  day  for  learn- 


60 


THERAPEUTICAL  INDICATIONS 


ing,  and  as  a practitioner  — mentions,  among  his  remedies,  the  bal- 
sam of  bats  for  hypochondriasis  ; remedies  taken  from  certain  parts 
of  adders;  sucking  whelps;  earth-worms;  mummy  made  of  the 
lungs  of  a man  who  died  a violent  death,  and  many  other  articles 
equally  gross,  and  irrational.  Even  a century  after  this  period  of 
defective  observation  and  experience,  no  great  advancement  had 
taken  place  towards  a knowledge  of  the  effects  of  medicines  on  the 
animal  economy.  The  doctrines  of  pathology  were  experiencing 
considerable  mutation  ; anatomy,  and  physiology  were  beginning  to 
be  vigorously  cultivated ; many  improvements  had  taken  place  in 
the  practice  of  medicine  and  surgery,  and  an  immense  number  of 
new  articles  had  been  added  to  the  materia  medica,  of  which  com- 
paratively few,  however,  have  been  since  retained ; yet  no  great  im- 
provement had  occurred  in  the  discrimination  oi false  from  true  facts, 
so  far,  at  least,  as  regards  the  medicinal  virtues  of  those  articles 
which  act  insensibly  on  the  frame,  and  which  have  been  commonly 
denominated  ‘‘  alteratives.” 

The  lists  of  the  materia  medica  of  this  country  and  of  Great  Bri- 
tain are  free  from  those  offsprings  of  superstition  and  credulity, 
although  they  may  be  objectionable  for  the  multitude  of  articles  ad- 
mitted into  them.  Time,  however,  and  improved  observation  and 
experiment  will  rectify  this  evil,  until  — fortunately  for  the  student, 
practitioner,  and  patient,  — the  list  will  embrace  those  agents  only, 
whose  virtues  and  applications  are  understood.  Valuable  time  is 
frequently  lost  in  the  exhibition  of  a remedy  of  doubtful  efficacy. 

Anceps  remedium  quam  nullum”  is,  indeed  a maxim  of  by  no 
means  universal  application.  The  safety  of  the  patient  is  often 
endangered  by  the  credulity  of  the  physician.  In  this  way,  the  use 
of  amulets,  anodyne  necklaces,  camphor  worn  round  the  neck,  &c., 
is  objectionable.  Presuming  on  their  prophylactic  or  remedial  pow- 
ers, the  wearer  is  apt  to  pass  rashly  into  infected  situations,  when  he 
would  otherwise  have  been  cautious,  and,  if  attacked  with  disease, 
postpones  the  employment  of  efficacious  remedies  until  the  time  has 
gone  by  for  their  successful  administration. 

Different  bezoards  or  calculi  found  in  the  stomachs  of  animals, 
and  at  one  time  generally  presumed  to  have  the  power  of  warding 
off  contagious  diseases,  were  to  be  found  in  the  pharmacopoeias  of 
Amsterdam,  Brunswick,  Spain,  and  Wirtemberg.  A distilled  water 
of  young  swallows  — officinally  called  Aqua  hirundinum  cum  cas- 
toreo  — existed  in  the  pharmacopoeia  of  Manheim,  as  an  anti-hysteric 
and  anti-epileptic;  — the  oniscus  or  woodlouse  in  most  of  the  Euro- 
pean pharmacopoeias,  as  a remedy  in  dropsy,  and  asthma ; — the 
powder  of  the  dried  frog,  Bufo  exsiccatus,  in  the  pharmacopoeias  of 
Spain  and  Wirtemberg,  as  an  anti-hydropic;  the  powder  of  the 
human  skull  in  the  same  pharmacopoeias,  as  an  anti-epileptic  ; 
the  dried  liver  of  the  mad  dog,  and  that  of  the  wolf,  in  the  pharma- 
copoeia of  Wirtemberg,  as  an  anti-hydrophobic ; the  Egyptian 
mummy  in  those  of  Spain  and  Wirtemberg,  with  the  hoof  of  the 


MODIFIED  DY  MENTAL  AFFECTIONS. 


61 


stag,  formerly  regarded  as  a specific  in  epilepsy ; besides  many  other 
articles  equally  absurd.  Their  retention  is  unfavourable  to  the  sci- 
entific observation  and  induction  of  the  people  into  whose  pharma- 
copoeias they  are  received  ; and  it  is  somewhat  surprising,  that  amidst 
the  various  pharmacopoeias  of  German  origin,  that  of  Wirtemberg 
should  be  so  far  behind  in  rejecting  the  relics  of  ancient  ignorance. 
A useful  lesson  may,  however,  be  deduced  from  all  these  facts. 
Many  of  the  articles  are  calculated  to  produce  considerable  effect 
upon  the  imagination,  and  thus,  they  may  really  have  been  produc- 
tive of  advantage  in  the  treatment  of  disease.  Who,  for  example, 
could  be  told,  that  he  was  about  to  take  a pill  made  of  the  powder 
of  the  human  skull,  or  of  an  Egyptian  mummy,  without  considera- 
ble emotion  ? Accordingly,  it  will  be  found,  that  most  of  these 
disgusting  agents,  as  well  as  of  the  various  nauseous  remedies, 
yet  retained  in  the  pharmacopoeias, — assafetida,  castor,  skunk-cab- 
bage, &c.,  — are  administered  to  the  nervous,  and  the  hysterical,  as 
well  as  in  the  various  affections  that  occur  in  paroxysms,  to  make  a 
powerful  impression  on  the  nervous  system,  and  thus  detract  from 
the  nervous  irritation  already  existent.  In  this  way,  we  account  for 
the  action  of  many  anti-spasmodics,  anti-epileptics,  anti-hysterics, 
febrifuges  administered  for  arresting  intermittents,  &c.  ; and  for  the 
efficacy  of  those  methods  of  acting  on  the  imagination,  — animal 
magnetism,  Perkinism,  &c.,  — that  have  excited  the  most  extrava- 
gant enthusiasm,  and  then  died  away,  leaving  scarcely  a vestige  of 
their  having  been;  but  maybe  resuscitated  under  some  other  form, 
unless  the  experience  of  the  past — by  which,  however,  mankind 
are  slow  to  profit — and  the  rapid  diffusion  of  intellectual  and  moral 
light  should  be  sufficient  to  choke  them  at  their  resurrection. 

Perkinism,  one  of  the  most  arrant  delusions  in  the  whole  history 
of  credulity,  is  the  product  of  our  own  soil.  Its  proposer  — Elisha 
Perkins  of  Connecticut  — is  represented  to  have  been  a man  of 
strict  honour  and  integrity  ; but  manifestly  of  an  ardent  imagina- 
tion, and  unbounded  credulity.  Impressed  with  the  idea,  that  me- 
tallic substances  might  exert  some  agency  on  the  muscles,  and  nerves 
of  animals,  and  be  inservient  to  useful  purposes,  as  external  agents, 
in  the  treatment  of  disease,  he  professed  to  institute  various  experi- 
ments, until  he  ultimately  fancied  he  had  discovered  a composition, 
which  would  serve  his  purpose,  and  of  which  he  formed  his  “ me- 
tallic tractors.”  These  consisted  of  two  instruments,  — one  having 
the  appearance  of  steel,  the  other  of  brass.  They  were  about  three 
inches  long,  and  pointed  at  one  extremity  ; and  the  mode  of  their 
application  was  to  draw  the  points  over  the  affected  parts  in  a down- 
ward direction  for  about  twenty  minutes  each  time.  The  effects 
seemed  to  be  miraculous.  The  whole  class  of  diseases  on  which 
the  imagination  is  known  to  exert  its  efficacy,  — and  it  will  be  seen 
afterwards,  that  it  is  most  extensive,  — rheumatism,  local  pains  of 
various  kinds,  and  in  various  parts,  paroxysms  of  intermittents,  &c., 

VOL.  I. — 6 


62 


THERAPEUTICAL  INDICATIONS 


yielded  as  if  by  magic.  The  operation  was  termed  Perkinism  by 
the  faculty  of  Copenhagen,  in  honour  of  the  inventor  ; and  institu- 
tions were  formed  in  Great  Britain,  which  were  regarded  for  a 
time  — that  is,  during  the  existence  of  the  delusion  — as  sources 
for  the  dispensation  of  health  to  suffering  thousands.  The  follow- 
ing is  from  the  report  of  the  “ Perkinistic  Committee”  of  London 
on  the  establishment  of  their  institution ! “ Mr.  Perkins,”  (the  son 

of  the  proposer)  “ has  annually  laid  before  the  public  a large  col- 
lection of  new  cases,  communicated  to  him  for  that  purpose,  by  dis- 
interested and  intelligent  characters  from  almost  every  quarter  of 
Great  Britain.  In  regard  to  the  competency  of  these  vouchers,  it 
will  be  sufficient  simply  to  state,  that,  amongst  others,  whose  names 
have  been  attached  to  their  communications,  are  eight  professors  in 
four  different  universities ; twenty-one  regular  physicians,  nineteen 
surg^ns,  thirty  clergymen,  twelve  of  whom  are  Doctors  of  Divinity, 
and'ffiumerous  other  characters  of  equal  respectability.  The  cases 
published  by  these  gentlemen  in  March  last,  the  date  of  Mr.  Per- 
kins’ last  publication,  amount  to  about  five  thousand.  Supposing 
that  not  rnore  than  one  cure  in  three  hundred,  which  the  tractors 
have  performed,  has  been  published  — and  the  proportion  is  proba- 
bly much  greater  — it  will  be  seen,  that  the  number  to  March  last 
will  have  exceeded  one  million  five  hundred  thousand.'^’’  With  such 
apparentl^i  overwhelming  testimony  in  its  favour,  can  we  be  much 
surprised,  that  sufficient  enthusiasm  should  have  been  excited 
amongst  the  credulous,  for  the  establishment  of  the  Perkinistic  In- 
stitution ^ A meeting  was  called  for  the  purpose  ; the  undertaking 
was  unanimously  resolved  upon,  and  a subscription  opened  to  carry 
the  proposed  charity  into  effect.  The  list  was  soon  honoured  by 
above  a hundred  subscribers,  several  with  a donation  of  ten  guineas, 
and  only  one  or  two  subscribing  annually  less  than  one  guinea. 
Lord  Rivers  was  elected  President  of  the  Society ; and  eleven  other 
persons  of  distinction,  among  whom  was  Governor  Franklin,  son  of 
the  illustrious  Doctor,  composed  the  list  of  vice-presidents.  On  the 
25th  of  July,  1803,  a large  house  was  opened  in  Frith  street,  Soho 
square,  for  the  reception  of  patients,  and  in  which  the  medical 
attendant,  matron,  and  servants  constantly  resided.  The  objects  of 
this  establishment  — as  stated  by  the  society  in  their  publication  on 
the  subject  — appeared  to  be  philanthropic,  and  were  as  follows:  — 
First.  To  afford  relief  to  the  disorders  of  the  afflicted  and  industrious 
poor  of  the  metropolis,  if  the  remedy  should  be  found  capable  of 
that  desirable  purpose  : and — Secondly.  To  submit  the  long  con- 
troverted question  on  the  merits  of  the  metallic  tractors  to  the  test 
of  the  severest  scrutiny,  the  ordeal  of  experiment  by  disinterested 
persons,  and  thereby  enable  the  public  to  form  a correct  opinion  on 
the  just  pretensions  of  Perkinism:”  — and  it  was  farther  proposed, 
in  the  report  of  the  committee,  that  the  British  Parliament  should 
investigate  the  merits  of  Perkinism,  “ and  if  convinced  of  its  utility, 
honour  it  with  similar  patronage  to  other  modern  discoveries  for  the 


MODIFIED  BY  MENTAL  AFFECTIONS. 


63 


benefit  of  mankind.”  Yet,  humiliating  reflection  ! In  a very  brief 
space  of  time,  the  enthusiasm  and  the  institution  died  away  ; and 
no  one,  at  the  present  day,  believes  that  the  effect  was  any  thing 
more  than  an  additional  illustration  of  the  success  that  must  ever  ' 
follow,  for  a time,  the  efforts  of  empiricism  and  pretension.  Whilst 
the  delusion  regarding  Perkinism  was  at  its  height,  Dr.  Haygarth 
determined  to  ascertain  how  far  the  effects  might  be  ascribed  to  the 
imagination.  He  accordingly  formed  pieces  of  wood  into  the  shape 
of  tractors,  and  with  much  assumed  pomp  and  ceremony  applied 
them  to  a number  of  sick  persons,  who  had  been  previously  pre- 
pared to  expect  something  extraordinary.  He  not  only  employed 
them  in  nervous  diseases,  but  in  all  kinds  of  cases ; and  the 
effects  were  found  to  be  astonishing.  Obstinate  pains  of  the  limbs 
were  suddenly  cured.  Joints,  that  had  been  long  immovable,  were 
restored  to  motion,  and,  “ in  short,”  says  Dr.  Bostock,  ‘‘  except  the 
renewal  of  lost  parts,  or  the  change  of  mechanical  structure,  nothing 
seemed  beyond  their  power  to  accomplish.” 

Animal  magnetism,  as  well  as  the  employment  of  the  magnet  for 
the  cut-e  of  disease,  is,  at  the  present  day,  exerting  its  therapeutical 
influence,  partly  through  the  same  agencies.  It  is  in  such  cases  as 
those  in  which  the  tractors  were  found  beneficial,  that  they  succeed. 

All  these  facts  lead  us  back  to  the  great  influence  exerted  by  the 
moral  on  the  physique.  Daily  experience  shows  how  satisfactorily  a 
case  of  disease  may  proceed,  if  the  faith  of  the  patient  be  implicitly 
yielded  to  the  physician,  and  to  the  mode  of  treatment  he  is  pursuing  ; 
and  how  unhappily  every  thing  is  apt  to  go  on,  when  the  contrary  is 
the  fact.  The  author  has  already  cited  a case,  in  which  the  same 
remedy  had  opposite  effects,  when  prescribed  by  two  different  phy- 
sicians — the  confidence  of  the  patient  being  reposed  in  the  one,  and 
not  in  the  other.  It  is  equally  important,  for  the  successful  opera- 
tion of  a medicine,  that  the  confidence  of  the  patient  should  be  re- 
posed in  it,  otherwise  disappointment  is  apt  to  ensue  ; and,  on  the 
other  hand,  imagination  or  faith  may  render  inert  medicines  effica- 
cious, and  may  even — as  before  remarked  — cause  a medicine  to 
have  effects  very  different  from  those  which  it  usually  exerts. 

A female  patient  was  admitted  into  the  County  Asylum  at  Hanwell, 
under  Sir  William  Ellis.  She  imagined  she  was  labouring  under  a 
complaint  which  required  the  use  of  mercury  ; but  Sir  William  dis- 
covering that  the  idea  of  the  existence  of  that  disease  was  an  insane 
delusion,  yet  considering  that  flattering  the  opinion  of  the  lunatic  to 
a certain  degree  might  be  favourable  to  her  recovery,  prescribed 
bread  pills  for  her,  and  called  them  mercurial  pills  ; after  a few  days, 
she  was  salivated,  and  the  pills  were  discontinued.  On  again  pre- 
scribing them  after  the  salivation  had  subsided,  she  was  a second 
time  affected  in  the  same  manner ; and  this  happened  again  on  a 
third  recurrence  to  the  use  of  the  pills. 

The  late  Dr.  James  Gregory,  of  Edinburgh,  was  in  the.  habit 
of  relating  an  anecdote  in  his  lectures,  in  illustration  of  the  same 


C4 


TilEAAPEUTICAL  IxVDICATIONS 


subject.  A student,  who  was  labouring  under  fever,  and  who 
was  under  the  care  ol  the  doctor,  required  the  administration  of  an 
anodyne  ; and  he  was  accordingly  informed  by  the  doctor,  that  he 
would  order  one  for  him,  to  be  taken  at  bed-time.  The  patient, 
however,  thought  he  said  cathartic.  The  next  morning,  when  the 
doctor  called,  he  inquired  what  effect  the  anodyne  had  produced  ? 
“ Anodyne  !”  replied  the  young  man,  “ I understood  it  was  a pur- 
gative, and  a very  active  one  it  has  proved.  I have  had  four  copious 
stools,  and  feel  much  relieved.’’  In  Paris’s  life  of  Sir  Humphry 
Davy  there  is  a case  equally  instructive.  Dr.  Beddoes  having  in- 
ferred, that  the  inhalation  of  the  nitrous  oxide  must  be  a specific  for 
palsy,  a patient  was  selected  for  trial,  and  placed  under  the  care  of 
young  Davy.  Previous  to  administering  the  gas,  Davy  inserted  a 
small  thermometer  under  the  tongue  of  the  patient  to  ascertain  the 
temperature.  The  paralytic,  deeply  impressed  by  Dr.  Beddoes  with 
the  certainty  of  the  success  of  the  remedy,  of  which  he  knew  nothing, 
no  sooner  felt  the  thermometer  in  his  mouth  than  he  declared  he  felt 
better.  Nothing  more  was  done,  and  the  sick  man  was  requested  to 
return  on  the  following  day.  The  same  ceremony  w^as  repeated  wdth 
the  same  result,  and,  at  the  end  of  a fortnight.,  he  was  dismissed  cured., 

— no  remedy  of  any  kind,  except  the  thermometer,  having  been 
used  ! 

In  an  interesting  account  of  the  influence  exerted  on  the  public  health 
of  Hamburg,  by  the  great  fire  there  in  1842,  Dr.  Zimmerman  states  that 
many  bedridden  invalids  arose,  and  displayed  supernatural  force  and 
energy  ; and  that  some  of  them  remained  permanently  cured.  Diar- 
rhoea, mania,  and  apoplexy  'were  the  principal  diseases  observed. 

It  will  be  easily  understood,  then,  how  important  and  extensive 
may  be  the  influence  exerted  by  the  mind  over  the  body,  in  a thera- 
peutical point  of  view,  and  that  it  is  not  unimportant  to  inquire  into 
the  likes  and  dislikes,  the  prepossessions  and  antipathies,  of  patients. 
It  Avill  often  happen,  that  in  the  course  of  a long  disease  a desire  may 
be  felt  for  particular  articles  of  diet,  which  may  not  seem,  at  first 
sight,  extremely  appropriate;  but,  in  such  cases,  unless' manifest 
evil  would  be  likely  to  result,  it  is  better  to  humour  the  individual 
slightly,  or  at  least  not  to  resist  him  strongly  ; for  it  occasionally 
happens,  that  instinctive  desires  or  appetites  are  felt,  which  may  not 
only  be  indulged  in  moderation  wdth  impunity,  but  with  obvious 
benefit.  The  refrigerant  regimen  w^as  at  one  time  carefully  avoided  ; 

— so  long  indeed  as  the  doctrine  of  concoction  of  humours  persisted  ; 
and  one  of  the  greatest  improvements  in  the  practice  of  physic,  as 
applied  to  febrile  diseases,  is  the  free  adoption  of  the  cooling  system, 
whenever  the  state  of  the  body  will  admit  of  it.  Instinct  here  led 
the  way,  and  experience  has  proved  the  correctness  of  its  monitions. 
The  efforts  of  the  practitioner,  in  a case  of  simple  fever,  are,  indeed, 
mainly  restricted  to  the  employment  of  the  refrigerant  class  of  reme- 
dies. A prejudice  is  still  found,  however,  against  the  use  of  icec\ 
water  in  fever  where  calomel  is  given.  The  feeling  exists  strongly 


MODIFIED  BY  PROFESSIONS,  ETC. 


65 


in  many  parts  of  the  Southern  and  Middle  states,  but  it  is  rapidly 
yielding,  and  ought  to  be  altogether  abolished.  Some  cases  have 
occurred  in  which  individuals  have  caught  cold,  or  have  had  dis- 
agreeable symptoms  supervening,  after  cold  water  has  followed  calo- 
mel ; but  they  have  been  cases  of  the  post  hoc,  rather  than  of  the 
propter  hoc.  The  author  has  been  for  years  in  the  habit  of  allowing 
the  use  of  iced  water  after  calomel  in  fevers,  and  has  never  had  the 
slightest  evidence  of  any  disagreeable  results  from  it. 

7.  PROFESSIOPJS,  AND  WAY  OF  LIFE. 

These  circumstances  exert  much  influence  not  only  on  the  suscep- 
tibility to  disease,  but  on  the  indications  of  cure,  and  the  mode  in 
which  these  indications  have  to  be  fulfilled.  This  is  strikingly  ex- 
emplified in  the  agency  of  those  physical  circumstances,  that  affect 
the  economy  through  the  mucous  membrane  of  the  digestive  tube. 
If  this  has  been  regularly,  and  for  a long  period,  excited  beyond  its 
healthy  action  by  the  use  of  alcoholic  potations,  not  only  is  the  foun- 
dation laid  for  diseases  in  other  organs,  but  the  whole  frame  becomes 
liable  to  unhealthy  inflammatory  excitement,  on  the  application  of 
causes,  which  would  have  been  incapable  of  producing  the  same 
results  on  the  individual  before  his  system  had  been  thus  inordinately 
excited.  The  draymen,  porters,  coal-heavers  and  others  of  the 
British  metropolis,  who  drink  a gallon  or  more  of  strong  porter  during 
the  day,  and  daily,  although  they  bear  the  appearance  of  rude  health, 
are  liable  to  erysipelatous  inflammation  after  the  slightest  external 
injury  ; and,  when  attacked  by  severe  internal  disease,  do  not  bear 
the  abstraction  of  blood  like  those  of  sound  constitution  and  tempe- 
rate habits. 

But,  independently  of  such  habits,  mode  of  life  has  a manifest 
effect  upon  the  organism.  The  labourer,  who  is  exposed  to  every 
vicissitude,  is  less  susceptible  of  impressions,  and  consequently  de- 
mands larger  doses  of  medicines  to  produce  the  same  effect,  than  he 
who  is  brought  up  in  idleness  and  luxury.  The  effect  of  such  habits 
is  to  render  the  frame  extremely  impressible,  and  hence  the  number 
of  the  nervous  and  the  hysterical  is  infinitely  greater  amongst  the 
upper  classes  of  society.  In  this  country,  we  have  not  the  difference 
of  way  of  life  so  signally  exhibited  as  in  Oriental  climes,  where  a 
distinct  classification  exists  in  society.  Amidst  the  revolutions,  that 
occur  in  the  fate  of  families,  where  the  law  of  primogeniture  does 
not  hold,  there  is  not  much  opportunity  for  tracing  the  effects  of 
labour  or  of  luxury  through  many  generations ; but  in  Hindustan, 
where  a difference  of  castes  has  existed  from  time  immemorial,  and 
where  the  barriers  are  effectually  closed  so  as  to  prevent  the  entrance 
of  the  unprivileged,  the  effect  is  clearly  shown.  The  artisans  are 
above  the  tillers  of  the  soil,  and  they  exhibit  in  their  conformation, 
as  well  as  in  their  functions,  the  influence  of  a greater  degree  of  re- 
finement. The  same  remark  applies  to  the  Polynesians,  where  a like 
(division  exists. 

6* 


G6 


THERAPEUTICAL  INDICATIONS 


ft  is  in  the  investigation  of  disease  that  the  knowledge  of  the  pro- 
fession or  calling  is  a more  important  topic  of  inquiry  than  in  Thera- 
peutics. In  order  to  appreciate  accurately,  in  many  cases,  the  causes 
and  seat  of  a disease,  the  nature  of  the  daily  occupation  must  be 
known.  The  flax-dresser,  for  example,  the  glass-cutter,  the  needle- 
pointer,  &c.,  are  liable  to  diseases  of  the  chest,  owing  to  the  minute 
])articles  given  off  in  their  operations  entering  the  lungs,  and  ex- 
citing irritation  there,  so  as  to  produce  many  and  fatal  pulmonary 
maladies.  Lead,  again,  gives  rise  to  a series  of  symptoms,  which 
have  been  called,  collectively,  ‘ lead  colic,’  or  colica pictonum.  When 
a person,  consequently,  labouring  under  those  symptoms,  presents 
himself  to  the  pathologist,  the  inquiry  suggests  itself,  whether  he  may 
not  belong  to  one  of  those  occupations  in  which  lead  is  used,  — as 
in  smelting  the  metal,  manufacturing  sheet  lead,  or  white  lead, 
plumbing,  glazing,  painting,  and  composing  in  printing  offices.  By 
handling  the  metal,  the  carbonate  of  lead  gets  upon  the  fingers,  and 
is  swallowed,  provided  due  cleanliness  be  not  adopted.  That  ihis 
is  the  mode  in  which  the  poison  of  lead  is  often  received  into  the 
system  is  shown  by  the  fact,  that  at  an  extensive  smelting  establish- 
ment in  Cornwall,  at  which  cases  of  colica  pictonum  were  extremely 
common,  the  disease  was  almost  abolished  after  an  order  had  been 
issued,  and  rigorously  enforced,  that  no  artisan  should  be  permitted 
to  partake  of  food  until  he  had  washed  his  hands  carefully  with  the 
assistance  of  a nail-brush. 

These  inquiries  are  altogether  etiological,  and  they  afford  us  ex- 
amples of  the  cessation  of  the  effect  after  the  removal  of  the  cause. 
Reference  has  already  been  made  to  the  fact,  that  although  this  may 
often  follow,  — in  an  immense  multitude  of  cases,  the  diseased  action 
may  still  persist  after  the  removal  of  the  cause.  In  the  large  class 
of  diseases,  that  are  symptomatic,  every  thing  depends  upon  the  ac- 
curate investigation  and  appreciation  of  the  primary  lesion;  and  this 
is  often  one  of  the  most  difficult  points  of  pathological  inquiry. 
“ The  greatest  attention  of  the  physician,”  says  Begin,  “ is  often 
required  to  enable  him  to  discover  the  real  causes  of  the  disease 
before  him.  A few  months  ago  I was  called  to  a woman  labouring 
under  oppression  of  the  chest,  with  a dry  and  frequent  cough,  and 
a painful  sense  of  suffocation  recurring  at  intervals  : besides  these 
symptoms,  there  was  constant  headache  and  vertigo,  the  conjunctiva 
was  injected  ; and  the  pulse  was  full,  hard,  and  not  much  acceler- 
ated. For  two  months  her  menses  had  disappeared,  in  consequence 
of  a violent  mental  affection.  A copious  bleeding,  warranted  by 
her  vigor  and  youth,  caused  a subsidence  of  the  cerebral  symp- 
toms ; the  menses  re-appeared  ; but  the  pectoral  symptoms  con- 
tinued. During  ten  or  fifteen  days,  I directed  my  treatment  against 
what  I considered  to  be  irritation  — either  sanguineous  or  nervous 
— of  the  bronchi,  but  unsuccessfully.  At  last,  during  one  of  my 
visits  whilst  conversing  with  my  patient,  I observed  her  executing 


MODIFIED  BY  CAUSES,  ETC.,  OF  THE  DISEASE. 


67 


that  remarkable  motion  which  accompanies  difficult  and  painful  de- 
glutition. On  my  inquiring  whether  she  often  had  to  execute  that 
motion,  she  answered  in  the  affirmative.  I then  proceeded  to  ex- 
amine the  mouth  : a slight  irritation  existed  about  the  pharynx  and 
tonsils;  the  uvula  was  elongated,  filiform,  and  descended  along  the 
base  of  the  tongue  as  far  as  the  epiglottis.  The  true  cause  of  the 
disease  was  now  disclosed.  The  exuberant  appendage  of  the  velum 
palati  was  immediately  removed  in  the  usual  way,  and  all  the  symp- 
toms disappeared.” 

This  case  is  not  novel  — although  M.  Begin  seems  to  regard  it 
so.  It  has  long  been  admitted,  that  elongation  of  the  uvula,  by 
irritating  the  top  of  the  larynx,  may  develope  the  ordinary  symp- 
toms of  phthisis,  in  such  as  are  predisposed  to  the  disease ; 
and  it  can  readily  be  seen,  that  if  tubercles  already  exist  in 
the  lungs,  it  may  excite  them  to  suppuration.  M.  Begin,  how- 
ever, uses  the  case  cited  as  the  foundation  for  a remark,  “ that  cir- 
cumstances of  this  kind  are  not  unfrequent.  The  ‘ physiological 
doctrine,’  in  unfolding  the  origin  and  nature  of  a vast  number  of 
symptoms,  heretofore  co.nsidered  as  essential  affections,  has  dimi- 
nished the  catalogue  of  diseases,  and  rendered  their  treatment  more 
methodical  and  efficacious.”  The  “ physiological  doctrine,”  has  cer- 
tainly not  been  without  its  good  fruits  ; but  the  case  selected  by  M. 
Begin  to  prove  this  is  not  a happy  one.  It  was  not  the  doctrine,  that 
attracted  his  attention  to  the  uvula,  but  the  symptoms,  and  they 
would  equally  have  done  so,  had  no  “ physiological  doctrine”  ever 
existed.  The  “ doctrine”  has  been  as  much  injured  by  injudicious 
friends  as  by  open  enemies  ; and  it  is  partly  owing  to  want  of  dis- 
cretion, that  it  is  now  scarcely  spoken  of,  except  as  a matter  of 
medical  history. 

8.  CAUSES,  SEAT,  PERIOD,  &c,  OF  THE  DISEASE. 

Enough  has  been  said  respecting  the  modifications  of  the  indica- 
tions, and  the  mode  of  fulfilling  them,  according  to  the  causes,  and 
seat  of  the  malady.  It  need  scarcely  be  remarked,  that  the  period 
of  the  disease  likewise  exerts  considerable  influence,  and  is  occa- 
sionally a source  of  difficulty  to  the  therapeutist.  In  febrile  diseases, 
the  use  of  stimulants  has  been  almost  abandoned  ; but  cases  at 
times  occur,  when  they  seem  to  be  indicated,  and  the  practitioner 
is  compelled  to  proceed  with  caution,  and  to  decide  with  judgment, 
in  his  appreciation,  whether  they  be  indicated  or  the  contrary.  Dr. 
Rush  affirmed,  that  there  was  a period  in  fevers,  when  blisters  might 
be  had  recourse  to  with  advantage  as  stimulants,  and  to  this  period 
he  gave  the  name  blistering  point.”  If  the  excitement  was  above 
this  point,  blisters  were  improper;  if  below,  the  contrary.  The 
difficulty  would  manifestly  be  to  know  it.  It  is  not  fixed  with  ther- 
mometric accuracy,  and,  consequently,  the  idea  of  the  blistering  point 
fell  to  the  ground  with  its  distinguished  proposer'.  It  will  be  seen, 
too,  hereafter,  that  blisters  are  by  no  means  unobjectionable  agents 


68 


THERAPEUTICAL  INDICATIONS 


in  the  very  cases,  referred  to  by  Dr.  Rush  as  requiring  the  adminis- 
tration of  excitants. 

In  inflammatory  affections,  the  period  of  the  disease  occasions 
modifications,  which  cannot  escape  the  observant  practitioner.  In- 
flammation is  apt  to  terminate  in  various  ways,  and  it  is  important 
for  the  therapeutist  to  determine  whether  such  termination  — as  it  is 
technically  called  — has  supervened;  inasmuch  as  many  of  the  ordi- 
nary signs  of  inflammation  may  be  still  kept  up  in  consequence  of 
the  disordered  action  persisting,  to  a greater  or  less  extent,  in  the 
aflfected  tissues.  Pneumonia,  for  example,  may  end  in  the  effusion 
of  a serous  fluid  into  the  lungs,  or  into  the  cavity  of  the  pleura;  and 
this  fluid  may  keep  up  irritation  there.  The  excited  state  of  vessels, 
too,  may  continue  in  the  seat  of  inflammation,  though  not  to  the 
same  extent;  and  a very  different  system  of  medication  may  be  ad- 
visable from  that  which  was  adopted  before  such  effusion  occurred ; 
or  at  least  the  same  activity  of  management  may  be  altogether  in- 
admissible. In  like  manner,  in  the  inflammations  of  mucous  mem- 
branes, which  have  persisted  for  a long  time  — or,  in  other  words, 
have  become  chronic  — excitant  applications  are  made  to  take  the 
place  of  the  soothing,  which  were  adopted  in  the  earlier  stages  with 
obvious  advantage. 

Under  different  states  or  conditions  of  the  body,  remedies  are 
found  to  produce  the  most  various  effects.  During  the  existence  of 
spasm  in  any  portion  of  the  system,  opium  may  be  given  in  immense 
quantities  without  inducing  its  wonted  action.  The  author  has  sat 
by  the  bedside  of  a delicate  female,  labouring  under  the  cfiolelithus 
means  of  Good  — that  is,  under  gallstone  in  its  progress  along  the 
ductus  communis  choledochus  — to  whom  he  has  given  tincture  of 
opium  by  the  tea-spoonful,  until  she  took  upwards  of  an  ounce,  yet 
without  any  stupor  following  its  administration.  In  like  manner,  in 
neuralgia,  extreme  doses  of  narcotics  may  be  demanded,  as  well  as 
in  mania  and  melancholia,  delirium  tremens,  tetanus,  hydrophobia, 
&c.  — diseases  in  w^hich  the  cerebro-spinal  nervous  system  is  pro- 
foundly aflfected,  and  in  which  the  great  nervous  centre  can  be  im- 
pressed with  extreme  difficulty.  It  is  but  lately,  that  an  interesting: 
lady,  labouring  under  puerperal  mania,  took  twelve  grains  of  solid 
opium  in  the  period  of  twenty-four  hours ; and  an  engineer  of  one  of 
the  Philadelphia  steamboats,  affected  with  a severe  neuralgic  attack 
in  the  intestines,  took  fifteen  grains  in  the  same  time  ; and  much 
larger  doses  than  these  have  been  given  under  similar  circumstances 
without  the  least  evidence  of  narcosis. 

It  is  unnecessary  to  dwell  upon  this  point.  In  every  case  of 
diseased  manifestation,  the  mode  of  treatment  has  to  be  modified  by 
the  intensity,  character,  and  period  of  the  affection,  whether  the 
morbid  action  be  above  the  medium  line  or  below  it ; or,  in  other 
words,  whether  excitants  or  sedatives  appear  to  be  indicated  from 
the  first. 


MODIFIED  BY  CAUSES,  ETC.,  OF  THE  DISEASE. 


69 


To  sum  up.  — It  has  been  shown,  that,  amongst  the  most  import- 
ant circumstances,  which  modify  the  indications  of  cure  in  disease, 
and  the  mode  of  fulfdling  those  indications,  are,  — age,  sex,  original 
conformation,  habit,  climate,  mental  affections,  professions,  and  way 
of  life,  as  well  as  the  causes,  period,  and  seat  of  the  disease;  and 
that  all  these  have  to  be  attended  to,  in  order,  that  the  therapeutist 
may  be  enabled  to  administer  his  medicinal  agents  with  judgment 
and  efficiency. 


70 


ACTION  OF  MEDICINES. 


CHAPTER  III. 

OF  MEDICINES. 

A medicine  defined — General  action  of  Medicines — Various  modes  of  action— By  sim- 
ple, direct  or  local  action — By  indirect  or  general  action — Through  the  nerves — Through 
absorption — Through  revulsion — Medicines  divisible  into  Excitants  and  Sedatives  — 
Classification  of  medicines — Barbier’s  Classification — A.  T.  Thomson’s  Classification 
— Author’s  Classification. 

A Medicine,  in  the  enlarged  sense,  is  any  agent  which  is  adminis- 
tered for  the  purpose  of  curing  or  allaying  morbid  action.  The  de- 
finition would  include  the  different  articles  of  diet  and  regimen,  which 
are  employed  medicinally  ; and  if  we  were  to  go  into  a nicety  of 
definition,  we  might  have  to  point  out  the  difference  between  ali- 
ments, medicines,  and  poisons  ; but  this  is  unnecessary.  The  term 
is  well  understood  to  be  appropriated  to  those  agents,  that  are  had 
recourse  to  therapeutically  ; or,  in  other  words,  to  the  various  arti- 
cles, which  are  received  into  the  pharmacopoeias  or  dispensatories, 
or  which,  in  consequence  of  their  action  upon  some  tissue  of  the 
body,  ought  to  be  received  into  them.  The  Greek  word 
signified  both  poison  and  medicine  ; and  the  generality  of  medicines 
are  capable  of  exerting  a deleterious  agency  if  administered  in  too 
large  a dose. 

Every  medicinal  agent  — to  produce  its  effect — must  impress  some 
surface  of  the  body,  and  it'must  perhaps  be  capable  of  impressing  the 
surface,  whether  in  a healthy  or  diseased  state.  To  this,  however, 
some  plausible  objections  might  be  urged, — both  directly,  and  from 
analogy.  For  example,  it  is  well  known,  that  the  secretions  do  not 
act  upon  the  parts  with  which  they  are  destined  to  come  in  contact, 
when  such  parts  are  in  a state  of  health  ; but  if  they  become  diseased, 
then  the  same  secretions  may  excite  violent  irritation.  This  is 
exemplified  in  ardor  urinse,  an  appellation,  which  indicates  a symp- 
tom, not  a disease.  When  the  lining  membrane  of  the  urethra  is 
healthy,  the  urine  passes  over  it  without  exciting  any  uneasy  sensa- 
tion; but  when  it  is  inflamed  — as  in  blennorrhoea  — the  healthy 
fluid  excites  violent  irritation,  and  such  a sensation  of  heat  as  to 
cause  the  mischief  to  be  ascribed  to  the  urine  ; — hence  the  name 
ardor  urince — and  the  French  name  chaudepisse. 

An  acrid  condition  of  the  bile  has  often  been  adduced  as  the 
cause  of  diarrhoea.  A better  pathology  teaches  us,  that  the  primary 
source  of  irritation  is  usually  — universally  perhaps  — in  the  lining 
membrane  of  the  digestive  tube,  and  that  the  liver  is  secondarily 
implicated; — a vitiated  condition  of  the  bile  being  very  rarely,  per- 
haps, the  main  cause  of  bowel  affections. 


MODUS  OPERANDI  OF  MEDICINES. 


71 


Again,  we  have  an  instance  in  which  the  same  remedy  has  very 
different  effects  according  to  the  varying  condition  of  the  organ.  Most 
of  the  believers  in  the  abortive  powers  of  the  Ergota  or  ergot  of  rye 
consider  it  devoid  of  action  upon  the  unimpregnated  uterus  : many 
of  them  think  it  is  capable  of  producing  abortion  ; and  all,  that  it 
adds  to  the  efficiency  of  the  parturient  efforts,  when  once  the  pro- 
cess has  become  established.  These,  and  other  facts,  might  induce 
us  to  accord  with  Sir  Gilbert  Blane,  and  Dr.  Paris,  that  medicines 
are  frequently  but  relative  agents,  producing  their  effects  in  reference 
only  to  the  state  of  the  living  frame  ; and  there  is  truth  in  the  remark 
of  Sir  Gilbert,  that  the  virtues  of  medicines  cannot  be  fairly  essay- 
ed, nor  beneficially  ascertained,  by  trying  their  effects  on  sound  sub- 
jects, because  that  particular  morbid  condition  does  not  exist,  which 
they  may  be  exclusively  calculated  to  remove;  ‘Ghus,  in  certain 
states  of  debility,  tonics  may  excite  the  system  when  languid,  by  their 
sympathetic  influence  upon  Xheprimce  vim  ; while  in  a robust  condition 
of  the  body,  the  effects  of  the  same  agents  may  be  wholly  inapprecia- 
ble.’’ As  a general  rule,  however,  we  should  be  justified  in  doubt- 
ing the  potent  medicinal  efficacy  of  any  agent,  which  produces  no 
effect  whatever  on  the  healthy  body. 

1.  MODUS  OPERANDI  OF  MEDICINES. 

The  modus  operandi  of  remedies  is  not  always  clear ; yet,  by  care- 
ful analysis,  we  can  generally  appreciate  it — in  the  main  results  at 
least,  — although  we  may  have  much  difficulty  in  comprehending  the 
precise  mode  in  which  these  results  are  accomplished.  This  applies 
especially  to  those  cases  in  which  the  agency  takes  place  by  sympa- 
thetic influence, — an  influence  proverbially  obscure,  and  frequently 
invoked  with  the  view  of  covering  the  ignorance  of  the  observer;  as 
vitality^  and  organic  action  are,  at  times,  used  by  the  physiologist, 
when  a function  cannot  be  explained  by  any  known  physical  facts 
or  arguments. 

The  modes  in  which  the  agency  of  remedies  is  exerted  are  chiefly 
as  follows. 


a.  BY  SIMPLE,  DIRECT,  OR  LOCAL  ACTION. 

When  a drug  is  taken  into  the  stomach,  it  may  merely  affect  that 
organ  by  simple  contact ; and  no  sensible  impression  may  be  made 
elsewhere.  This  is  the  simplest  mode  in  which  remedial  agents  act ; 
and  we  have  examples  of  the  same  kind  in  the  application  of  caustics 
to  parts,  which  we  are  desirous  of  eroding  or  destroying ; in  the  use 
of  astringents  in  hsematemesis,  and  in  cases  of  hemorrhoids  when 
the  remedy  is  applied  so  as  to  come  into  immediate  contact  with  the 
affected  parts  ; in  the  use  of  collutories  for  sore  mouth  ; of  external 
agents  in  ordinary  local  inflammation ; and  of  a poultice  in  suppu- 
rative inflammation. 

Inflammation,  according  to  its  degree,  affords  us  a good  example 
of  the  mode  in  which  disease  may  either  be  wholly  local,  or  impli- 


72 


ACTION  OF  MEDICINES 


cate  the  general  system;  and,  likewise,  of  the  way  in  which  our 
remedial  agents  may  affect  the  frame  locally  or  generally.  In  a 
slight  case  of  inflammation,  we  have  the  morbid  action  confined 
altogether  to  the  capillaries  implicated.  The  heart  and  larger  ar- 
teries do  not  participate ; and  the  efforts  of  the  practitioner  are  prin- 
cipally directed  to  the  use  of  agents,  whose  operation  may  be  confined 
to  the  inflamed  part.  But  if  the  inflammation  be  more  severe,  the 
whole  circulatory  system  sympathises,  and  remedies  are  required, 
which  will  act  both  on  that  system  generally,  and  on  the  vessels 
more  immediately  concerned.  At  times,  however,  w^e  see  the  very 
best  results  from  applications,  which  are  directed  simply  to  the  in- 
flamed part ; and  as  the  increased  action  becomes  soothed  in  the 
part,  the  soothing  influence  is  propagated  to  the  rest  of  the  system, 
in  the  same  manner  as  the  morbific  influence  was  in  the  first  instance. 
In  cases  of  inflammation  of  the  conjunctiva,  a few  drops  of  a weak 
solution  of  nitrate  of  silver,  thrown  on  the  eye,  will  often  allay  the 
irritation  almost  instantaneously,  and  the  increased  action  of  the  ves- 
sels communicating  with  the  over-dilated  capillaries  speedily  sub- 
sides; but  if,  on  the  other  hand,  a very  strong  solution  of  nitrate  of 
silver,  or  of  any  other  astringent,  be  dropped  on  the  diseased  eye, 
it  may  excite  intense  irritation  there,  and  the  vascular  apparatus  of 
the  part,  and  even  of  the  whole  system,  may  be  thrown  by  it  into  a 
state  of  turmoil.  If  we  then  soothe  by  appropriate  applications,  the 
turmoil  ceases.  In  these  last  cases,  we  have  examples,  not  only  of 
the  purely  local  or  direct  action  of  medicines ; but  also  of  the  exten- 
sion of  this  action  elsewhere,  — constituting  the  next  mode  of  ope- 
ration which  we  have  to  consider. 

b.  BY  INDIRECT  OR  GENERAL  ACTION. 

This  is  the  mode  commonly  adopted  in  the  administration  of  re- 
medies. In  most  cases  of  internal  exhibition,  the  agent  must  first 
come  in  contact  with  the  stomach,  and,  through  this  organ  — the 
great  ‘‘  centre  of  sympathies,”  as  it  has  been  long  considered,  and 
designated — other  parts  become  impressed,  according  to  the  elec- 
tive affinity  of  the  particular  article  for  some  tissue  or  organ  rather 
than  for  another.  It  is  owing  to  the  stomach  being  so  intimately 
associated  with  other  parts,  that  it  is  generally  chosen  as  the  organ, 
through  which  remedies  are  to  act.  If  the  functions  of  the  stomach 
be  disordered,  as  in  dyspepsia,  the  whole  system  sympathises ; there 
is  not  an  organ  that  does  not  feel  the  depressing  irradiations ; the 
brain  and  nervous  system  may  become  so  disordered  that  the  patient 
is  subject  to  all  kinds  of  hallucinations ; and  hypochondriasis  thus 
becomes  a common  concomitant  of  dyspepsia.  Nauseating  remedies, 
again,  exert  their  effect,  through  the  stomach,  on  the  whole  system, 
so  as  to  be  most  valuable  agents  in  diseases  of  increased  action  ; and, 
in  short,  as  the  different  parts  of  the  system  can  be  affected  by  im- 
pressions conveyed  through  the  stomach, — so,  conversely,  no  irrita- 
tion can  persist  for  any  great  length  of  time  in  any  organ  without  the 


THROUGH  THE  NERVES. 


stomach  suffering ; hence  it  is,  that  it  has  been  designated  the  centre 
of  sympathies. 

The  manner  in  which  this  indirect  effect  of  medicines  is  induced, 
is  as  follows. 


1.  Through  the  JYerves. 

Between  every  part  of  the  capillary  surface  of  the  body  there  is 
the  greatest  sympathy  or  consent ; so  that  if  any  one  be  inordinately 
and  irregularly  excited,  parts  at  a distance  sympathise  ; and  this  to  a 
greater  or  less  degree,  according  as  such  parts  are  more  or  less  dis- 
posed to  take  upon  them,  at  the  time,  a similar  derangement.  This 
is  seen  when  the  feet  are  exposed  to  cold  and  moisture  ; derange- 
ment takes  place  in  the  functions  of  the  capillaries  of  the  feet,  and  this 
derangement  is  reflected  to  every  part  of  the  capillary  surface,  so  that 
in  a dozen  individuals  exposed  to  this  cause  of  disease,  the  derange- 
ments may  be  as  various  in  their  seats  as  are  the  individuals  themselves ; 
owing  to  the  greater  predisposition  of  some  particular  organ  to  as- 
sume a morbid  action  in  one  rather  than  in  another.  Now,  that 
which  applies  to  the  external  capillary  surface  applies  equally  to  the 
internal  expansion  of  the  skin  forming  the  mucous  membranes,  so 
that  medicines  received  into  the  stomach,  by  impressing  the  capil- 
laries of  that  organ,  may  produce  sympathetic  results  on  parts  at  a 
distance. 

That  medicines  do  exert  their  influence  through  the  nerves  — as 
one  modus  operandi  — is  unquestionable.  Dupuy  divided  the  pneu- 
mogastric  nerves  in  a horse,  and  then  introduced  two  ounces  of  nux 
vomica,  in  the  form  of  a bolus,  into  the  stomach.  No  unpleasant 
consequences  followed  ; whilst  another  horse  — equal  in  size  and 
strength  to  the  former  — to  which  the  same  quantity  of  the  poison 
was  administered,  died  in  a few  hours  in  violent  tetanic  convulsions. 
It  is  probable,  that  the  reason  why  the  former  did  not  suffer,  was  the 
division  of  the  nerves  ; but  a doubt  might  be  raised,  with  much 
plausibility  in  its  favour,  whether  it  was  directly  dependent  upon 
this,  or  indirectly^  owing  to  the  function  of  absorption  having  been 
destroyed  by  the  section.  The  researches  of  modern  toxicologists 
have  indeed  furnished  us  with  cases  that  are  unequivocal ; one  of 
which  is  sufficient  for  our  purpose.  If  strong  hydrocyanic  acid  be 
applied  to  the  tongue  of  an  animal,  it  dies  instantaneously; — so  ra- 
pidly, indeed,  that  there  may  not  be  time  enough  to  remove  it  from 
the  lap  of  the  experimenter  before  life  has  ceased.  In  this  case,  it 
would  seem  to  be  impossible  for  the  poison  to  have  entered  the  blood- 
vessels, and  to  have  passed,  with  the  currenf  of  the  circulation,  to 
the  great  vital  organ  on  which  its  deleterious  agency  is  exerted.  In 
many  cases  of  poisoning,  death  is  doubtless  produced  by  the  action 
of  the  poison  on  the  nerves  distributed  to  the  coats  of  the  blood- 
vessels, — as  where  the  poison  is  injected  into  the  veins,  and  destroys 
life  instantaneously. 

Several  of  our  medicinal  agents,  it  will  be  found,  act  by  preference 

VOL.  I. — ^7 


74 


ACTION  OF  MEDICINES 


on  the  nervous  system,  and  of  these  all  do  not  act  upon  it  in  the  same 
way.  Opium,  for  example,  affects  the  brain,  causing  stupor  ; strych- 
nia, the  brain  and  spinal  marrow,  producing  tetanic  convulsions  ; 
and  prussic  acid  excites  coma  with  tetanus.  The  precise  ground  of 
these  differences  is  inscrutable  ; yet  that  they  exist  cannot  be  denied. 
There  is  a manifest  affinity  between  particular  remedial  agents,  and 
particular  parts  of  the  frame ; and  in  whatever  manner  these  agents 
are  administered  — whether  by  the  stomach,  or  by  the  skin,  or  by 
infusion  into  the  blood  — they  seek  out  the  organs  on  which  they  act 
by  preference  ; yet,  why  tartrate  of  antimony  and  potassa  should 
produce  vomiting,  when  injected  into  the  venous  s}^stem,  and  rhu- 
barb purge — why  this  elective  affinity  should  exist  — is  unknown. 

We  can  likewise  affect  distant  parts  by  applying  our  remedial 
agents  to  the  cutaneous  surface.  The  author  has  already  referred  to 
the  effect,  produced  on  the  capillary  system  elsewhere,  by  the  irre- 
gular action  induced  through  exposing  the  feet  to  cold  and  moisture. 
The  effect  of  ablution,  as  a refrigerant  in  fever,  is  another  example. 
If  the  skin  be  steadily  hot  and  dry,  cold  or  tepid  water  may  be  ap- 
plied by  ablution  or  sponging,  so  as  to  greatly  diminish  the  morbid 
heat;  and,  accordingly,  it  is  one  of  the  most  valuable  febrifuge 
remedies  which  we  possess.  The  capillary  system,  to  which  the 
cold  or  tepid  fluid  is  applied,  has  its  action  diminished,  and,  through 
that  extensive  sympathy,  which  has  been  mentioned  as  existing  be- 
tween every  part  of  the  capillary  system,  the  sedative  influence 
is  speedily  extended  to  the  rest  of  the  frame.  It  is  to  the  external 
capillary  surface  that  most  of  our  energetic  counter-irritants  or  revul- 
sives are  applied  ; although  we  shall  find,  that  various  local  stimu- 
lants, administered  internally,  are  indebted,  for  much  of  their  efficacy, 
to  the  derivation  or  revulsion  they  excite.  It  obviously  would  be  a 
matter  of  moment,  if  we  could  discover  the  parts  that  more  particu- 
larly sympathise  with  each  other,  in  order  that  our  revulsives  and 
other  agents  might  be  applied  with  full  effect,  but  this  is  a matter  of 
difficulty,  demanding  a degree  of  patient  investigation,  which  but 
few  possess. 

Dr.  Thomson  regards  the  organ  of  smelling  as  a third  medium  for 
receiving  the  impression  of  medicinal  agents  on  the  nervous  system  : 
the  effect,  he  remarks,  “ is  chiefly  produced  on  the  first  and  the  fifth 
pairs  of  nerves  distributed  over  the  Schneiderian  membrane,  lining 
the  nostril,  the  adjoining  sinuses,  and  the  convoluted  bones,  so  beau- 
tifully contrived  to  extend  this  surface  in  a limited  space  and  he 
adds,  that  “ many  substances,  which  are  supposed  to  enter  the  sys- 
tem by  pulmonary  absorption,  such  as  the  fumes  of  alcohol,  tobacco, 
and  ammonia,  affect  the  habit  solely  by  impressions  made  on  the 
nerves  of  smelling.’’  In  support  of  this  opinion,  he  quotes  numerous 
experiments  by  Dr.  Rousseau,  of  Philadelphia,  which  appeared  to 
warrant  the  conclusion,  that  by  simply  closing  the  nostrils,  either  by 
compressing  them  with  the  fingers,  or  by  filling  them  up,  the  fumes 
of  ardent  spirits,  or  of  a strong  decoction  of  tobacco,  or  an  infusion 
of  opium  might  be  inhaled  for  an  hour,  without  any  unpleasant  effect ; 


THROUGH  THE  NERVES. 


75 


whereas  if  the  precaution  were  omitted,  the  consequences  were  found 
to  be  most  distressing.  Notwithstanding,  however,  the  mode  in 
which  these  results  are  stated,  the  author  cannot  help  doubting  the 
accuracy  of  the  experiments,  and,  of  necessity,  the  deductions  founded 
upon  them.  When  these  substances  are  inhaled,  either  by  the  nose 
or  the  mouth,  they  come  in  contact  with  branches  of  the  fifth  pair  of 
nerves.  In  the  nose,  it  is  true,  they  impinge  also  upon  the  ramifica- 
tions of  the  first  pair  or  the  olfactories  ; but,  on  the  other  hand,  in 
the  mouth,  they  meet  with  branches  of  the  hypoglossal  and  glosso- 
pharyngeal. It  is  admitted,  that  more  effect  is  produced  on  the  ner- 
vous system,  when  they  are  passed  through  the  nose,  than  when  they 
traverse  the  mouth  ; but  this  is  perhaps  owing  to  the  greater  degree 
of  velocity  with  which  they  are  made  to  enter  the  former  than  the 
latter  cavity,  so  that  the  nasal  nerves  are  more  powerfully  impressed 
than  the  buccal,  and  — as  the  supporters  of  absorption  would  say  — 
their  entrance  into  the  circulation  through  the  mucous  membrane 
rendered  more  ready  ; but  it  is  not  necessary  — as  Dr.  Thomson 
thinks  is  the  general  belief  — that  such  absorption  should  be  pulmo- 
nary. All  the  mucous  membranes  are  absorbing  surfaces,  and  al- 
though a portion  of  the  fumes  may  pass,  along  with  the  inspired  air, 
into  the  ultimate  bronchial  ramifications,  and  be  there  absorbed,  im- 
bibition takes  place  in  every  part  of  the  mucous  membrane,  from,  the 
place  where  it  commingles  with  the  skin  at  the  mouth  to  the  point 
of  termination  of  the  minute  air-tubes  ; nor  did  the  author  know, 
that  any  one  entertained  the  opinion,  that  ammonia  enters  the  sys- 
tem by  pulmonary  absorption.  As  well  might  it  be  presumed,  that 
any  inorganic  and  mechanical  excitant,  applied  to  the  nasal  nerves, 
exerts  its  agency  by  such  absorption. 

Of  the  precise  mode  in  which  medicinal  agents  influence  the 
nerves,  we  know  little  or  nothing.  It  is  not  necessary,  that  the 
surface,  with  which  they  come  in  contact,  should  be  physically 
modified,  or  that  any  organic  change  be  perceptible.  In  the  case 
of  the  instantaneously  fatal  application  of  the  hydrocyanic  acid, 
to  which  reference  has  been  made,  there  is  no  time  allowed  for  the 
supervention  of  organic  modifications  in  the  part  to  which  it  is 
applied.  The  lethiferous  influence  is  at  once  exerted  on  the  nerves 
with  which  it  is  placed  in  contact,  and  the  irradiations  proceed  from 
thence  along  the  nerves  — with  the  rapidity  of  lightning  along  con- 
ducting wires  — to  the  great  vital  centres,  whose  action  ceases  on 
the  instant,  and  immediately  afterwards  that  of  every  tributary  organ. 

The  mode  in  which  the  influence  of  medicines  is  extended  to 
different  organs,  through  the  nerves,  probably  differs.  In  many 
cases,  the  impression  made  upon  the  part  to  which  the  agent  is 
applied  passes  immediately  to  the  brain,  and  is  thence  reflected  to 
the  sympathising  organ.  This  is  probably  the  way  in  which  medi- 
cinal agents  generally  produce  their  effect  through  sympathy;  but  in 
certain  cases  it  would  seem  that  this  reflection  is  not  indispensable. 
A demulcent,  by  passing  over  the  top  of  the  larynx,  may  produce  a 


76 


ACTION  OF  MEDICINES 


soothing  influence  there,  which  may  extend  to  other  parts  of  the 
pulmonary  mucous  membrane  — by  what  is  termed  sympathy  of  con- 
tinuity^ effected  perhaps  through  continuous  nerves.  In  the  same 
manner,  the  action  of  a suppository,  or  of  a glyster,  excites  the  upper 
parts  of  the  intestinal  tube  to  contraction.  Physiology  and  pathology, 
indeed,  furnish  multitudes  of  examples  of  this  kind  of  sympathy,  as 
well  as  of  the  sympathy  of  continuity^  of  which  we  have  an  instance, 
where  the  muscular  coat  of  the  intestines  is  aroused  to  increased 
action  by  the  irritation  of  a cathartic  on  the  mucous  coat;  or,  where 
we  attempt  to  produce  an  emmenagogue  effect  by  the  administration 
of  cathartics — such  as  the  preparations  of  aloes  — whose  action  is 
mainly  exerted  on  the  lower  part  of  the  bowels.  The  generality  of 
physiologists  of  the  present  day  look  to  the  nervous  system  as  the 
great  source  and  medium  of  communication  of  the  different  irradi- 
ations by  which  distant  organs  are  supposed  to  react  sympathetically 
upon  each  other.  The  rapidity,  indeed,  with  which  the  various 
actions  of  the  nervous  system  are  executed,  — the  apparent  synchro- 
nism between  the  reception  of  an  impression  on  an  organ  of  sense, 
and  its  perception  by  the  brain,  as  well  as  between  the  determinations 
of  the  wdll  and  their  effect  upon  a muscle,  — naturally  attracted  the 
attention  of  physiologists  to  this  system  as  the  instrument  of  sympathy ; 
and  we  certainly  know  enough  to  infer,  that,  in  many  cases,  in  ani- 
mals, the  nerves  appear  to  be  the  conductors;  that  the  brain  is,  in 
others,  the  centre,  to  which  the  organ  in  action  transmits  its  irradi- 
ations, and  by  which  they  are  reflected  to  the  sympathising  organ; 
whilst,  in  others,  again,  the  effect  is  caused  in  the  absence  of  nervous 
centre,  and  perhaps  even  of  nerves,  in  a manner,  which,  in  the 
present  state  of  our  knowledge,  is  inexplicable.  It  is  not  difficult, 
ho^vever,  to  conceive,  that  by  means  of  contractility,  impressions  — 
vibratory  or  other — may  pass  rapidly  from  one  part  of  the  organism 
to  another,  as  they  do  in  the  vegetable,  which  — if  we  admit  it  to  be 
possessed  of  a nervous  system  at  all  — has  it  in  a primitive  and  rudi- 
mental  form,  and  has  certainly  nothing  like  a nervous  centre  for  the 
reflection  of  impressions.  Vibrations,  it  is  well  known,  communi- 
cated through  the  air  from  a sonorous  body  when  struck,  impress  the 
organ  of  hearing:  light  probably  acts  in  a similar  manner  upon 
the  visual  apparatus,  and  we  may  suppose,  without  any  violence  to 
probability,  that  a similar  vibration  may  exist  over  the  organism, 
so  that  an  impression  made  upon  one  part  may  rapidly  oscillate  to 
another,  independently  of  any  thing  like  nervous  communication. 

2.  Through  Absorption, 

The  proofs,  that  medicines  may  be  absorbed  from  the  alimentary 
canal  and  elsewhere,  in  their  entire  state,  are  as  numerous  as  they 
are  satisfactory.  It  is  but  necessary,  that  a substance  should  possess 
the  requisite  tenuity  to  soak  through  the  coats  of  the  veins,  and,  in 
this  way,  get  into  the  circulatory  current.  The  facts  and  arguments, 
connected  with  the  absorbent  function  of  the  veins,  are  so  fully  de- 


THROUGH  ABSORPTION. 


77 


tailed  in  the  author’s  Human  Physiology,  that  a simple  reference  to 
them  here,  will  be  all  that  is  necessary.  But  few  physiologists  of 
the  present  day  doubt,  that  those  vessels  are  capable  of  this  function ; 
yet  it  is  denied  by  one  therapeutical  writer.  Prof.  Chapman,  of  Phila- 
delphia, that  medicines  can  pass  unchanged  into  the  venous  system, 
or,  in  other  words,  that  they  can  be  absorbed  in  their  entire  state : 
the  assertion  and  belief  are  designated  by  him  as  a ‘‘relict  of  the 
humoral  pathology;”  and  he  affirms,  that  “it  must  at  least  be 
acknowledged,  that  no  substance  in  its  active  state  does  reach  the 
circulation,  since  it  is  shown,  that  a small  portion,  even  of  the 
mildest  fluid  — as  milk,  or  mucilage,  oil,  or  pus  — cannot  be  injected 
into  the  blood-vessels,  without  occasioning  the  most  fatal  conse- 
quences.” 

Setting  aside  the  multitude  of  facts,  which  show,  that  substances 
may  be  absorbed  by  the  veins,  and  be  detected  by  chemical  re- 
agents in  the  blood,  we  know  well,  that  they  can  be  injected 
directly  into  the  blood  without  producing  death ; and  that,  since  the 
time  of  Harvey  until  the  present  day,  the  “infusion”  — as  it  has 
been  termed  — of  medicinal  agents  into  the  blood  has  been  a common 
practice.  It  is  asserted  to  have  been  first  employed  in  1657,  at  the 
suggestion  of  Sir  Christopher  Wren,  and  it  has  been  practised  at  the 
veterinary  school  of  Copenhagen,  with  complete  success,  — the 
action  of  the  agent  being  more  speedy,  and  the  dose  required  much 
less  when  thus  administered.  Experiments  of  this  kind  have  con- 
firmed the  well  known  but  singular  fact  — already  referred  to  — that 
medicinal  substances  exert  their  action  by  preference  upon  certain 
parts  of  the  body,  in  the  same  manner  as  if  they  had  been  received 
into  the  stomach.  Tartarised  antimony  vomits,  and  castor  oil  purges, 
not  only  as  certainly,  but  with  much  greater  speed;  for,  whilst  the 
former  requires  to  be  in  the  stomach  for  fifteen  or  twenty  minutes 
before  vomiting  is  excited,  it  produces  its  effects  in  one  or  tw’o 
minutes  when  thrown  into  the  veins.  Of  late  years,  the  custom  has 
been,  in  certain  diseases  and  in  numerous  experiments,  to  load  the 
blood-vessels  with  warm  water  so  as  to  induce  a state  of  preternatural 
fulness,  and,  in  cholera,  the  quantity  of  saline  solution  injected  has 
been  enormous.  The  great,  the  necessary  precaution  appears  to  be, 
that  the  fluid  should  not  be  too  viscid ; for  it  has  been  found,  that 
thick  fluids,  such  as  oil,  or  mixtures  of  powders,  are  unable  to  pass 
through  the  pulmonary  capillaries,  in  consequence  of  which  the  cir- 
culation is  arrested,  and  death  follows;  and  within  these  limits  the 
remark  of  Professor  Chapman  is  correct.  Such  was  the  result  of 
several  experiments  on  animals  with  powdered  substances,  under- 
taken by  an  enthusiastic  physician  of  Boston  — Dr.  E.  Hale,  junior, 
— who  had  nearly  fallen  a victim  to  an  experiment  of  the  kind  in- 
stituted on  himself.  Dr.  Hale,  desirous  of  observing  the  effects  of 
castor  oil  when  thus  injected,  attempted  to  pass  it  into  a vein  of  the 
arm;  he  experienced,  however,  considerable  difficulty  in  introducing 
it,  and  to  this  his  safety  has  been  ascribed.  Soon  after  the  injection 


7* 


78 


ACTION  OF  MFDICINFS 


/ 


he  felt  an  oily  taste  in  the  mouth,  which  continued  for  a length  of 
time,  and  the  medicine  acted  powerfully  as  a cathartic. 

Again,  a good  deal  depends  upon  the  mode  in  which  the  injec- 
tion is  sent  in,  — as  regards  velocity.  If  a drachm  of  healthy  bile 
be  suddenly  thrown  into  the  femoral  vein  in  a state  of  concentra- 
tion, death  soon  follows  ; but  if  it  be  suffered  to  pass  in  very  slowly, 
little  or  no  inconvenience  results.  It  was  the  opinion  of  Bichat, 
that  if  a bubble  of  air  should  accidentally  enter  the  venous  system, 
it  would  cause  death  ; but  the  experiments  of  Nysten  and  Magendie 
have  shown,  that  if  it  be  introduced  slowly,  no  unfortunate  event 
need  be  apprehended.  It  is  a cause  of  death  after  severe  surgical 
operations,  although  it  is  not  more  than  a quarter  of  a century  since 
the  ratio  moriendi^  in  such  cases,  was  first  suspected.  Some  animals 
will  admit  enormous  quantities  of  air  into  the  veins  without  perish- 
ing. Magendie  instances  the  case  of  a horse,  into  whose  veins  he 
sent,  as  rapidly  and  forcibly  as  he  was  able,  forty  or  fifty  pints  of 
air  without  occasioning  immediate  death,  although  the  animal  ulti- 
mately expired  ; and  Lepelletier  de  la  Sarthe  alludes  to  similar 
experiments  of  his  own,  from  which  he  infers,  that  the  fatal  action 
of  the  air  is  mechanical,  and  that  it  is  possible  to  prevent  the  result 
by  injecting  so  gradually,  that  the  blood  has  the  power  to  dissemi- 
nate, and  perhaps  even  to  dissolve  the  gas  with  sufficient  prompti- 
tude to  prevent  its  accumulation  in  the  cardiac  cavities.  No  doubt, 
then,  ought,  we  think,  to  exist,  that  medicines  can  be  absorbed  from 
the  stomach  or  elsewhere  in  their  entire  state,  and  that  when  once 
in  the  circulation  they  may  act  on  the  nerves  distributed  to  the  inner 
coat  of  the  vessels,  so  as  to  affect  the  great  nervous  centres,  or  may 
proceed  with  the  current  to  act  upon  those  organs  for  which  they 
have  a preference. 

Substances  may  be  absorbed  from  the  cutaneous  surface,  although 
this  is  infinitely  less  easy  than  from  its  prolongation,  which  consti- 
tutes the  mucous  membranes.  The  cuticle  is  a great  obstacle  to 
absorption,  for  if  it  be  removed  in  any  manner,  so  that  a substance, 
capable  of  absorption,  can  come  in  contact  with  the  vessels  of  the 
corpus  papillare,  absorption  takes  place  readily.  The  same  thing 
happens — to  a more  limited  extent  — if  we  force  the  substance  by 
friction  through  the  cuticle.  This  is  the  mode  in  which  we  affect 
the  system  by  means  of  mercurial  unguents.  We  select  a part  of 
the  body  where  the  cuticle  is  thinnest,  and  continue  the  friction  until 
the  globules  of  mercury  disappear,  or  until  it  has  been  forced  through 
the  cuticle  into  contact  with  the  corpus  papillare.  The  most  un- 
doubted evidence  exists,  that  mercury  enters  the  blood.  Dr. 
Colson  detected  it  by  introducing  plates  of  polished  brass  into  the 
blood,  which  became  covered  with  a coating  of  mercury;  and  Dr. 
Christison  affirms,  that  it  has  been  obtained  from  the  crassamentum 
of  persons  salivated,  when  no  mercury  could  be  detected  in  the 
serum.  Many  such  cases  have  been  recorded.  Moreover,  by 
means  of  the  microscope,  Dr.  Oesterlen  detected  minute  globules 


THROUGH  ABSORPTK^N. 


79 


of  mercury  in  the  tissues,  in  the  blood,  and  in  the  secretions  of  men 
and  animals  to  whom  mercurial  ointment  had  been  given  internally, 
and  applied  by  frictions  to  the  skin. 

I’he  method  of  administration  by  friction  is  called  the  iatraleiptic : 
the  one  which  consists  in  placing  remedies  in  contact  with  an  abraded 
or  vesicated  surface,  the  endermic.  The  latter  method  has  been 
chiefly  employed  in  recent  times,  and  it  has  been  advised  by  Bally 
and  others,  where  it  was  conceived  digestion  would  interfere  with 
the  action  of  the  drug,  — a succedaneum,  which,  according  to  the 
peculiar  views  of  Professor  Chapman,  would  be  wholly  inoperative, 
inasmuch  as  he  considers  every  section  of  the  absorbent  system  to 
be  endowed  with  the  power  of  digestion  and  assimilation,  and  the 
lymphatics  quite  as  conspicuously  as  the  lacteals;  a capacity  given 
as  a provision  of  nature  to  exclude  noxious  matters  from  the  circu- 
lation. This  opinion  is  a necessary  pendant  to  the  Professor’s  doc- 
trines regarding  the  mode  in  which  substances  can  enter  the  vessels. 

Substances  may  likewise  be  received  into  the  system,  in  their  en- 
tire state,  by  the  lungs.  The  whole  of  the  respiratory  apparatus  is 
lined  by  a mucous  membrane  resembling  that  of  the  digestive  pas- 
sages, and  as  the  substances,  which  enter  the  air  tubes,  are  extremely 
tenuous,  they  can  pass  with  facility  into  the  blood-vessels.  It  is 
with  this  view,  that  narcotic  and  certain  other  inhalations  are  em- 
ployed. The  different  respirable  gases  produce  their  effect  in  this 
way  ; and  hence  the  hilarity  caused  by  the  protoxide  of  azote  or  the 

laughing  gas  and  the  exciting  or  depressing  influences,  that  can 
be  produced  by  inhaling  appropriate  gases. 

Reference  has  already  been  made  to  the  opinion  of  Rousseau  and 
Thomson,  that  ardent  spirits  exert  their  intoxicating  influence  by 
impressing  the  nasal  nerves  ; but  it  is  more  likely,  that  much  of  the 
intoxicating  effect  produced  on  those  who  pump  ardent  spirits  from 
large  casks  into  small  vessels,  in  extensive  wholesale  establishments, 
is  owing  to  the  vapour  of  the  alcohol  entering  the  lungs  with  the 
inspired  air,  and  being  imbibed  by  the  pulmonary  vessels.  It  is 
probably  in  this  way,  that  miasmata  — both  terrestrial  and  animal  — 
exert  their  influence  ; — their  first  impression  being  made  either  on 
the  nerves  distributed  to  the  coats  of  the  pulmonary  blood-vessels, 
or  on  the  brain  when  carried  thither  with  the  circulatory  fluid.  That 
they,  occasionally  at  least,  act  in  the  former  way  seems  to  be  sug- 
gested by  the  rapidity  with  which  the  effects  are  exhibited,  when  a 
person,  who  — owing  to  previous  attacks  of  malarious  disease,  has 
been  rendered  unusually  susceptible  to  the  action  of  miasmata  — is 
subjected  to  their  influence. 

'rhus  far  attention  has  been  directed  to  the  absorption  of  medicinal 
substances  in  their  entire  state.  It  often  happens,  however,  that  they 
are  decomposed  prior  to,  or  after  entering  the  circulation.  One  writer 
on  Therapeutics,  already  cited.  Prof.  Chapman,  has,  indeed,  sup- 
posed, that  in  all  those  cases  in  which  salts  appear  to  have  entered  the 
blood  in  their  entire  state  they  are  decomposed  in  the  stomach  ; that 


80 


ACTION  OF  MEDICINES 


their  components  enter  the  circulation  under  the  influence  of  the  vital 
energies,  which  prevent  them  from  recombining  ; but  that,  as  soon 
as  they  reach  the  secretory  or  excretory  organs,  they  are  thrown,  as 
it  were,  beyond  the  sphere  of  those  energies ; and  their  chemical 
affinities  being  brought  into  play,  they  recombine,  and  the  substance 
is  again  perceptible,  or  can  be  detected,  by  tests,  in  the  excretions. 
A satisfactory  reply  to  this  hypothesis  is,  that  substances  have  actually 
been  detected,  in  their  entire  state,  in  the  blood  ; and  besides,  no 
great  advantage  to  the  economy  could  accrue  from  the  decomposition 
in  many  cases,  as  the  elements  would  be  more  injurious  than  the 
compound.  The  objections,  indeed,  to  this  view  are  signal.  When 
substances  can  pass  so  readily  into  the  vessels  by  imbibition,  there  is 
no  necessity  for  invoking  this  operose  process  ; and  it  has  been  seen, 
that  no  advantage  to  the  economy  could  result  from  it.  There  are, 
however,  many  medicinal  agents,  which  require  to  be  set  free  in  the 
stomach  before  they  can  act  on  that  organ.  When  certain  vegetable 
substances  are  administered,  especially  in  decoction  or  infusion,  the 
parts  that  are  susceptible  of  digestion,  — the  mucilage,  extractive, 
&c.,  — are  converted,  whilst  the  medicinal  component  exerts  its  ap- 
propriate agency.  Dr.  Thomson  thinks  it  is  to  this  circumstance, 
that  w’e  may  ascribe  the  time,  which  elapses  between  the  swallowing 
of  certain  medicines,  and  the  period  when  their  operation  becomes 
apparent.  Thus,”  he  says,  if  half  a drachm  of  powder  of  the 
root  of  ipecacuanha  be  swallowed,  from  fifteen  to  thirty  minutes 
generally  elapse  before  vomiting  is  produced,  a circumstance,  which 
we  may  fairly  attribute  to  the  envelopment  of  the  emetina  — the 
active  constituent  of  the  ipecacuanha,  in  the  wax,  gum,  starch,  and 
ligneous  matter  of  the  root ; it  cannot  exert  its  influence  until  ex- 
tricated from  these  by  the  process  of  digestion.”  But  this  is  not  a 
happy  illustration  of  his  position,  inasmuch  as  the  same  length  of 
time  is  required  for  the  emetic  operation,  when  ipecacuanha  is  given 
in  forms  that  are  devoid  of  these  vegetable  accompaniments,  as  in  the 
vinum  ipecacuanhcB  of  the  pharmacopoeias,  or  in  the  various  prepara- 
tions of  its  active  ingredient  — emetia.  Tartar  emetic,  too,  is  as  long 
in  inducing  emesis,  although  it  is  well  adapted  for  rapid  absorption, 
or  for  instantaneous  action  on  the  nerves  of  the  stomach.  It  will  be 
seen  hereafter,  that  a more  satisfactory  mode  exists  of  accounting  for 
the  delay  in  the  operation  of  both  these  useful  drugs,  when  exhibited 
for  the  purpose  of  acting  as  emetics. 

Almost  all  writers  on  pharmacology  affirm,  that  the  acetate  of 
potassa  is  decomposed  in  the  stomach, — the  acid  being  digested, 
whilst  the  alkali  passes  into  the  circulation,  and  is  excreted  by  the 
kidneys.  This,  however,  may  be  questioned, — at  least  as  regards 
a part.  The  free  acids,  which  are  present  in  the  stomach  in  a state 
of  health,  are  the  chlorohydric,  and  the  acetic;  and  if  the  alkali 
of  the  acetate  of  potassa  were  set  free  during  digestion,  a part 
at  least  would  be  laid  hold  of  by  the  chlorohydric  acid,  and  enter 
the  circulation  as  chloride  of  potassium.  The  fact  of  the  existence 


THROUGH  ABSORPTION. 


8L 


of  those  acids  in  the  healthy  stomach  shows,  that  many  substances, 
when  taken  into  that  organ,  must  undergo  decomposition  through 
their  agency.  In  the  case  of  the  acetate  of  potassa, — the  free  chlo- 
rohydric  acid,  doubtless,  lays  hold  of  all  the  potassa,  unless  the 
quantity  of  the  acetate  be  very  large.  In  the  dyspeptic,  affected 
with  unusual  predominance  of  acid,  any  alkaline  carbonate  taken 
into  the  stomach  excites  effervescence,  in  the  same  manner  as 
when  added  to  the  chlorohydric,  or  acetic  acid  out  of  the  body. 
Nitrate  of  silver  is,  a substance,  which  can  rarely  or  never  enter  the 
circulation  unchanged.  It  is  possessed  of  caustic  properties,  and  is 
often  used  to  destroy  fungous  granulations  in  wounds  and  ulcers. 
When  applied  in  such  cases,  the  nitrate  is  decomposed  by  the  animal 
matter  with  which  it  is  made  to  come  in  contact ; the  oxide  of  silver 
remains  on  the  surface,  and  by  exposure  to  the  air,  becomes  black. 
If  the  salt,  too,  be  taken  internally,  for  any  length  of  time,  it  is  apt 
to  produce  a leaden  hue  of  the  surface.  “ Now  it  is  evident,”  says 
Dr.  Thomson,  f^that  this  effect  could  not  take  place  if  the  nitrate  of 
silver  were  not  taken  into  the  circulation  in  an  undecomposed  state  : 
for  if  the  nitrate  were  decomposed  in  the  stomach,  and  converted 
into  muriate  of  silver,  this  is  an  insoluble  salt,  and  consequently  not 
fitted  to  be  taken  up  by  the  absorbents.  But  if  we  admit,  that  the 
nitrate  of  silver  is  taken  into  the  circulation  in  its  undecomposed 
state,  we  can  readily  explain  the  manner  of  its  decomposition  by  the 
capillary  vessels  of  the  skin,  and  its  deposition  in  the  rete  mucosum, 
in  the  state  of  an  insoluble  muriate,  which  would  necessarily  render 
any  tinge,  communicated  by  it  to  the  skin,  permanent.”  It  is  diffi- 
cult to  see  how  the  nitrate  can  escape  decomposition  from  the  chlo- 
rohydric acid  always  existing  in  the  healthy  stomach,  as  well  as 
from  the  chloride  of  sodium,  which  is  present  in  the  humours.  It  is 
probable,  indeed,  that,  in  the  small  quantity,  in  which  it  is  admi- 
nistered internally,  it  never  enters  the  circulation  in  the  state  of 
nitrate,  but  always  in  that  of  chloride;  which, — as  Dr.  Thomson 
properly  remarks, — is  insoluble  ; but  this  is  not  an  insuperable  ob- 
stacle to  its  absorption.  Calomel  is  equally  insoluble,  yet  we  want 
no  proof,  that  the  system  is  capable  of  being  readily  affected  by  it. 
The  insoluble  chloride  of  silver  enters  the  sanguiferous  system,  is 
deposited  in  the  corpus  mucosum,  and — under  the  influence  of  light — 
is  converted  from  a white,  to  a dark  violet  colour, — an  effect,  which 
can  be  easily  proved,  by  exposing  chloride  of  silver  to  light,  out  of 
the  body. 

The  corrosive  chloride  of  mercury  or  corrosive  sublimate  some- 
times undergoes  a conversion  of  great  interest  to  the  toxicologist. 
It  may  happen  that  a person  has  been  poisoned  by  the  corrosive 
chloride,  and  yet  there  may  be  no  evidence  of  the  presence  of  any 
thing,  except  the  mild  chloride  or  calomel.  In  such  case,  how  are 
we  to  know,  whether  the  mild  chloride  be  the  result  of  the  decom- 
position of  the  corrosive  chloride,  or  whether  the  person  may  not 
have  taken  the  mild  chloride  a short  time  prior  to  dissolution. 


82 


ACTION  OF  MEDICINES 


When  the  corrosive  chloride  meets  with  albuminous  matters,  it  is 
decomposed  by  them,  and  is  converted  into  mild  chloride  ; but,  in 
such  case,  the  mild  chloride  is  intimately  united  with  them,  and  if  the 
decomposition  has  been  produced  by  the  animal  matter  of  the  coats 
of  the  intestines,  it  will  be  intimately  united  with  these  tunics 
whilst,  if  the  mild  chloride  has  been  taken  prior  to  dissolution,  it 
may  be  observed  lying  upon  the  mucous  surface,  and  in  no  way 
amalgamated  with  it. 

Sometimes  it  would  seem,  after  an  article  has  passed  into  the 
circulation,  it  is  decomposed,  either  in  the  blood,  or  in  some  of  the 
organs.  If  we  force  mercury  through  the  skin,  we  can  affect  the 
salivary  glands,  and  whilst  the  system  is  pervaded  by  the  mercury, 
a gold  watch  exhibits,  by  its  white  coating,  that  the  mercury  is  ex- 
haled by  the  cutaneous  surface.  In  like  manner,  if  blue  pill,  or 
calomel,  be  administered  in  adequate  quantity  internally,  the  watch 
will  be  equally  coated  by  the  mercury.  We  do  not  know  the  exact 
condition  of  the  exhaled  metal  in  these  cases ; whether,  in  the  case 
of  the  mercurial  ointment  and  blue  pill,  it  be  still  oxide, — in  the 
state  of  calomel,  still  mild  chloride;  — or  whether,  in  all  these  in- 
stances, it  be  not  decomposed,  and  given  off  in  the  form  of  mercu- 
rial vapour.  The  fact,  that  metallic  mercury  has  been  detected  in 
the  bodies  of  such  as  have  died  under  its  influence,  leads  us  to  pre- 
sume, that  the  metal  may  be  reduced,  and  exhaled  in  the  form  of 
vapour,  so  as  to  occasion  the  coating  in  question. 

When  substances  enter  the  blood  by  absorption,  if  they  can  che- 
mically combine  with  any  of  the  principles  of  that  fluid,  they  probably 
do  so  ; but  this  is  not  accomplished  so  readily,  as  might  have  been 
presumed,  owing  to  the  quantity  of  organic  matter,  which  frequently 
interferes  largely  with  inorganic  affinities.  Out  of  the  body,  we 
have  full  opportunity  for  witnessing  the  changes  induced  by  the 
gases,  and  by  various  agents,  on  the  blood  prior  to  coagulation,  and 
whilst  still  endowed  with  vitality.  They  are  signal ; and  similar 
changes  would,  doubtless,  be  produced,  could  the  same  agents  be 
applied,  in  the  same  state  of  concentration,  to  the  blood  whilst  cir- 
culating in  the  vessels.  Numerous  experiments  have  shown,  that 
when  certain  substances  have  been  given  for  a long  time,  the  blood 
is  rendered  much  thinner  ; whilst  directly  contrary  effects  are  ob- 
served to  follow  the  use  of  others  ; — the  coagulum  being  firmer,  and 
the  blood  of  a deep,  or  dark  colour.  As  the  pabulum,  therefore,  of 
the  different  nutritive  processes  is  modified,  we  can  readily  compre- 
hend, that  the  functions  of  secretion  and  nutrition  may  be  import- 
antly modified  also. 

The  difference  in  the  rapidity  with  which  the  absorption  of  me- 
dicinal agents  is  accomplished  is  great.  It  is  dependent  upon  the  de- 
gree of  distention  of  the  vessels,  and  on  the  existence  or  absence  of 
erethism  in  the  part.  If  polyaemia  or  vascular  fulness  exists,  absorp- 
tion is  tardily  effected  ; but  if  blood-letting  be  premised,  the  sub- 
stance speedily  passes  through  the  coats  of  the  blood-vessels,  and 


THROUGH  REVULSION. 


83 


enters  the  circulation.  In  some  experiments  by  Magendie,  in  which 
water  was  injected  into  the  vessels,  so  as  to  produce  a state  of  arti- 
ficial plethora,  and  a fluid  was  thrown  into  a serous  cavity,  it  was 
found,  that  whilst  the  state  of  plethora  existed,  none  of  the  fluid 
entered  the  circulation;  but  when  blood  was  drawn  from  a vein, — 
as  it  was  abstracted,  the  fluid  in  the  serous  cavity  rapidly  disap- 
peared under  the  eye  of  the  observer,  by  soaking  through  the  coats 
of  the  vessels,  and  entering  the  circulatory  current.  Hence  it  is, 
that  in  those  active  effusions  or  transudations  into  serous  cavities, 
which  constitute  dropsies,  blood-letting  is  a most  philosophical  and 
energetic  remedy. 

It  has  been  said,  that  the  activity  of  absorption  is  greatly  de- 
pendent upon  the  existence  or  absence  of  erethism  in  the  part.  If 
the  lining  membrane  of  the  intestinal  canal  be  in  a state  of  great 
irritation  or  inflammation,  the  digestive,  and  other  absorptions,  are 
no  longer  accomplished.  This  is  strikingly  the  case  in  malignant 
cholera,  which  usually  consists  of  a peculiar  excitation  in  the  capil- 
laries of  the  intestinal  mucous  membrane.  Under  this  excitation, 
the  watery  portions  of  the  blood  are  exhaled,  until  that  fluid  is,  in 
many  cases,  left  so  thick,  as  to  be  unable  to  pass  along  the  vessels  ; 
and  this,  notwithstanding  nutritive  fluids  may  have  been  constantly 
and  freely  administered.  It  is,  on  this  account,  also,  that  there  is 
frequently  so  much  difficulty  in  affecting  gastro-enteritic  patients 
with  mercury.  In  the  last  stages  of  many  of  the  bilious  and  ty- 
phoid forms  of  fever,  the  absorbent  function  of  the  intestines  is 
almost  annihilated,  in  consequence  of  the  irritation  in  the  mucous 
membrane  of  the  digestive  tube. 

C.  THROUGH  REVULSION. 

There  is  yet  another,  and  a most  important  mode,  in  which  medi- 
cinal agents  exert  their  efficacy,  viz.,  by  revulsion^  or  derivation.  It 
is  a general  rule,  in  the  animal  economy,  that  two  diseased  actions 
do  not  readily  go  on  at  the  same  time  with  the  like  degree  of  in- 
tensity. This  has  been  the  subject  of  remark  for  ages,  and  for  all 
ages  ; and  many  popular  remedies  have  been  suggested  by  a know- 
ledge of  the  fact.  When  any  morbid  action  is  going  on  in  the  sys- 
tem, and  a new  source  of  irritation  is  artificially  excited,  it  often 
happens,  that  the  new  irritation,  by  attracting  the  nervous  and  vas- 
cular afflux  to  it,  detracts  or  derives  from  the  internal  morbid  action, 
so  as  to  diminish,  or  wholly  remove  it.  It  is  in  this  way  that  blis- 
ters, and  the  various  counter-irritants,  issues,  setons,  moxas,  &c., 
produce  their  beneficial  effects,  not  by  the  discharge  which  they  oc- 
casion. Hence  it  is,  too,  that  good  results  from  a popular  remedy, — 
the  application  of  a garlic  poultice  to  the  thumb  in  cases  of  tooth- 
ache. But  these  are  only  marked  examples  of  revulsion.  It  results, 
likewise,  from  the  action  of  every  local  stimulant.  It  follows  the  use 
of  cathartics,  and  is  the  way  in  which  their  chief  remedial  agency 
is,  in  many  cases,  exerted.  In  head  affections,  especially  in  apo- 


84 


ACTION  OF  MEDICINES 


plcxy,  a revulsion,  thus  effected,  is  often  most  salutary;  and  for  this 
purpose,  when  deglutition  is  impracticable,  and  even  when  not, 
powerfully  stimulating  enemata  are  thrown  into  the  rectum  with  de- 
cided advantage.  In  like  manner,  the  milder  cathartics  may  be 
productive  of  benefit  in  gastro-enteritic  affections  by  the  succession 
of  sympathies,  which  they  induce,  in  passing  over  the  different  tracts 
of  the  intestinal  canal.  Diuretics,  and  in  short,  as  already  remarked, 
all  local  stimulants  owe  a part  of  their  efficacy  to  revulsion  ; and 
some  of  the  most  valuable  agents  we  possess  in  the  treatment  of 
protracted  disease,  — as  mercury  and  iodine,  — are  often  employed 
with  no  other  view.  The  avowed  object  of  the  practitioner  is  to 
excite  a new  action;  or  in  other  words  to  produce,  artificially,  a 
new’  condition  of  the  system  of  nutrition,  which  may  remove  that, 
which  has  been  so  long  existing. 

The  doctrine  of  revulsion  reposes  on  the  received  belief,  that 
diseases  are  cured  by  remedies  that  are  counter  to  them,  — co7i- 
traria  contrariis  medentur  but  an  imposing  medical  sect  has  at- 
tempted, and  is  attempting,  to  overthrow  this  doctrine,  and  to  set  up 
the  opposite, — similia  similibus  medentur The  Homceopathists, 
as  they  are  termed,  maintain,  that  there  are  remedial  agents,  w’hich 
can  produce  symptoms  similar  to  those  of  disease,  and  that  every 
dynamic  affection  of  the  living  organism  can  be  destroyed  by  an- 
other of  still  greater  intensity,  and  permanence,  that  strongly  re- 
sembles it.  They  maintain,  indeed,  that  the  curative  virtues  of  me- 
dicines are  solely  dependent  upon  the  resemblance  their  symptoms 
bear  to  those  of  the  disease.  There  are  but  three  modes,  they 
affirm,  of  applying  medicines  in  disease  ; the  liomceopathic ; 

secondly^  the  allopathic  or  heteropathic^  — the  method  in  general  use, 
which  is  said  by  them  never  to  regard  that  which  is  really  diseased 
in  the  body,  but  to  attack  parts  that  are  sound,  in  order  to  draw^  off 
the  malady  from  another  quarter,  and  direct  it  towards  the  latter  ; 
and  thirdly^  the  antipathic^  enantiopathic^  or  palliative  : by  w'hich 
method  they  affirm,  physicians  have,  till  the  present  time,  succeeded 
in  affording  apparent  relief,  and  gained  the  confidence  of  their  pa- 
tients, by  deluding  them  with  a temporary  suspension  of  their  suf- 
ferings. 

Upwards  of  a quarter  of  a century  ago,  Samuel  Hahnemann  — the 
founder  of  the  ‘‘homoeopathic  medical  doctrine,”  — first  propounded 
his  opinions  in  the  authoritative  form  of  the  “ Organon  der  rationellen 
HeilJmndej^^  — “ Organum  of  rational  medical  science^'’  The  book 
was  issued  from  the  Dresden  press,  but  did  not  at  first  attract,  in 
a marked  manner,  the  attention  of  physicians.  In  1S19,  a second 
edition  appeared,  under  its  present  title,  — the  epithet  rationellen^  or 
rational^  having  been  omitted.  Since  that  time,  it  has  passed  through 
different  editions,  and  the  English  reader,  who  is  not  a German 
scholar,  is  now  enabled  to  peruse  it  through  the  medium  of  a trans- 
lation by  Mr.  Devrient,  with  notes  by  Dr.  Stratten,  of  Dublin. 

It  is  not  the  author’s  intention  to  inquire  into  the  principles  and 


THROUGH  REVULSION. 


85 


merits  of  this  fantastic  doctrine  at  length  ; but  a few  observations 
may  be  made  upon  it.  Cinchona  appears  to  have  been  the  first  drug 
experimented  with  by  Hahnemann.  Whilst  occupied  in  translating 
the  Materia  Medica  of  Cullen  into  his  own  tongue,  he  was  dissatisfied 
with  the  explanation  of  the  febrifuge  powers  of  that  drug,  and  deter- 
mkied  to  make  trials  upon  himself.  He  took  it  in  considerable  quan- 
tity, while  in  perfect  health,  and  found  it  produced  symptoms  like 
those  of  ague.  Hence,  he  inferred,  that  intermittents  are  removed 
by  cinchona,  in  consequence  of  its  exciting  in  the  system  a morbid 
condition,  similar  to  that  for  the  removal  of  which  it  is  administered. 

Again,  say  the  homoeopathists,  — mercurial  preparations,  when  ad- 
ministered internally,  produce  symptoms  — local  and  constitutional 
— so  closely  resembling  the  symptoms  of  syphilis,  that  medical  prac- 
titioners, who  have  spent  years  in  the  investigation  of  syphilis,  find  it 
difficult,  and  in  some  instances  impossible,  to  distinguish  one  disease 
from  the  other.  If  the  venereal  poison  produces  pustules,  scales 
and  tubercles,  mercury  does  the  same.  If  syphilis  is  attended  with 
inflammation  of  the  periosteum  and  caries  of  the  bones ; so  is  the 
action  of  mercury.  Inflammation  of  the  iris  from  lues,”  says  Dr. 
Stratten,  “ is  an  every  day  occurrence  ; the  same  disease  is  a very 
frequent  consequence  of  mercury.  Ulceration  of  the  throat  is  a com- 
mon symptom  of  syphilis ; the  same  affection  results  from  mercury. 
Ulcers  on  the  organs  of  reproduction  are  the  result  of  both  the  poison 
and  the  remedy ; and  furnish  another  proof  of  the  doctrine  similia 
similibus.  Nitric  acid  is  generally  recommended  in  cutaneous  dis- 
eases ; the  internal  use  of  this  remedy,  in  a very  dilute  form,  produces 
scaly  eruptions  over  the  surface  of  the  body  ; and  the  external  ap- 
plication of  a solution,  in  the  proportion  of  one  part  acid  to  one 
hundred  and  twenty-eight  parts  water,  will  produce  inflammation 
and  ulceration  of  the  skin.  These  observations  would  lead  to  the 
conclusion,  that  nitric  acid  cures  cutaneous  diseases,  by  the  facility 
it  possesses  of  producing  a similar  disease  of  the  skin.  Nitrate  of 
potash,  administered  internally,  in  small  doses,  produces  a frequent 
desire  to  pass  water,  accompanied  with  pain  and  heat.  When  this 
state  of  the  urinary  system  exists  as  a consequence  of  disease,  or  the 
application  of  a blister,  a very  dilute  solution  of  the  same  remedy 
has  been  found  beneficial.  The  ordinary  effects  of  hyoscyamusniger 
are  vertigo,  delirium,  stupefaction,  and  somnolency.  Where  one  or 
other  of  these  diseased  states  exists,  it  yields  to  small  doses  of  the 
tincture  of  this  plant.  The  internal  use  of  hyoscyamus  is  followed 
by  mental  aberration,  the  leading  features  of  which  are  jealousy  and 
irascibility.  When  these  hallucinations  exist,  this  remedy  is  indi- 
cated. Opium  in  general  causes  drowsiness,  torpor,  and  deep  sleep  ; 
and  yet  this  remedy,  in  small  doses,  removes  these  symptoms  when 
they  occur  in  disease.  Sulphur  is  a specific  against  itch  ; notwith- 
standing which,  when  it  is  administered  to  healthy  individuals,  it 
frequently  excites  a pustular  eruption  resembling  itch  in  every  par- 
ticular.” 

VOL.  I. — 8 


8G 


ACTION  OF  MEDICINES 


Dr.  Stratton  asserts,  that  these  deductions  are  drawn  from  actual 
experiment ; and  so,  we  are  told,  are  all  the  positions  advanced  by 
the  homcEopathists. 

ddie  doses  of  medicines,  administered  by  them  are  infinitesimally 
small ; the  deeillionth  degree  of  dilution  is  not  uncommon.  The 
following  extract  from  Hahnemann’s  treatise  on  chronic  diseases, 
will  show  to  what  an  extent  the  farce  is  carried. 

Of  homcEopathic  medicines,  take  one  grain  of  those  which  are 
solid,  (mercury  being  included  in  the  number,)  or  one  drop  of  those 
which  are  liquid  ; put  this  small  quantity  on  about  the  third  part  of 
a hundred  grains  of  pulverised  sugar  of  milk  in  a porcelain  capsule 
that  is  not  glazed  ; then  mix  the  medicine  and  the  sugar  of  milk 
together  for  a moment,  with  a spatula  of  bone  or  horn,  and  pound 
the  whole  strongly  during  six  minutes.  The  mass  is  then  detached 
from  the  bottom  of  the  capsule  and  pestle  during  four  minutes,  in 
order  that  it  maybe  perfectly  homogeneous,  and  then  rub  down  afresh 
during  six  minutes  with  equal  force.  Collect  the  whole  of  the  pow- 
der into  a body  during  four  minutes,  then  add  the  second  third  por- 
tion of  the  sugar  of  milk,  and  mix  the  whole  for  an  instant  with  a 
spatula  ; then  triturate  with  force  during  six  minutes.  This  is  to 
be  once  more  scraped  together  during  four  minutes,  and  rubbed 
again  for  six  minutes.  Stir  the  whole  together  during  four  minutes, 
and  add  the  last  third  portion  of  the  sugar  of  milk,  which  is  to  be 
mixed  by  turning  it  about  with  the  spatula  ; then  triturate  the  mass 
powerfully  during  six  minutes,  scrape  it  together  during  four  minutes, 
and  the  whole  is  finally  to  be  rubbed  down  for  six  minutes.  After 
the  powder  has  been  carefully  detached  from  the  capsule  and  pestle, 
put  it  into  a phial,  and  let  it  be  corked  and  labelled  with  the  name 
of  the  substance,  and  the  mark  Too,  which  shows  that  the  substance 
is  in  the  hundredth  degree  of  attenuation.  To  carry  the  medicine 
to  the  ten  thousandth  degree  of  attenuation,  take  one  grain  of  the 
powder  marked  Tod,  prepared  as  above,  add  the  same  to  the  third 
part  of  an  hundred  grains  of  pulverised  sugar  of  milk,  mix  the  whole 
in  the  capsule,  and  proceed  in  such  manner,  that  after  having  tritu- 
rated each  third  portion  with  force  during  six  minutes,  scrape  the 
mass  together  during  a space  of  four  minutes.  The  powder,  when 
thus  prepared,  is  put  into  a well  corked  bottle  with  the  figures  id, 000 
marked  on  the  exterior,  which  will  point  out  its  degree  of  attenua- 
tion. The  same  method  is  observed  when  this  second  powder 
inarked  io,000  is  to  be  carried  to  the  millionth  degree  of  attenua- 
tion,” &c.,  &c. 

The  homoeopathic  method  can  only  be  regarded  as  a branch  of 
the  expectant  stem  ; and  it  is  liable  to  every  objection  that  applies  to 
the  latter.  The  hornoeopathists  argue,  however,  that  inasmuch  as 
Very  small  portions  of  a chemical  substance  can  be  detected  in  a 
solution,  so  may  minute  portions  be  capable  of  impressing  the 
organism.  For  example  — say  they  — one  grain  of  nitrate  of  silver, 
dissolved  in  one  thousand  five  hundred  and  sixty  grains  of  distilled 


THROUGH  REVULSION. 


S7 


water,  will  yield  an  evident  gray  precipitate  — perceptible  in  every 
part  of  the  fluid  — when  two  grains  of  muriatic  acid  are  added  to  it ; 

— and  again, — when  one  grain  of  iodine  is  dissolved  in  a drachm 
of  alcohol,  and  mixed  in  the  same  quantity  of  distilled  water  as  in 
the  last  case,  and  to  this  two  grains  of  starch,  dissolved  in  an  ounce 
of  water,  are  added,  an  evident  blue  tint  is  produced  in  the  solution. 
In  these  experiments,  consequently,  the  grain  of  the  nitrate  of  silver 
and  iodine  must  have  been  divided  into  one-fifteen  thousand  two 
hundred  and  sixtieth  of  a grain.  These  experiments,  however,  are 
in  no  wise  elucidative  of  the  position;  — for  although  such  minute 
portions  of  chemical  agents  may  be  detected  by  the  senses,  it  by  no 
means  follows,  that  they  can  exert  a remedial  action.  Accordingly,  it 
is  affirmed  byM.  Andral,  that  when  the  homceopathic  system  has  been 
impartially  tried,  it  has  not  been  found  to  succeed  in  the  manner 
asserted  by  its  supporters.  Like  the  expectant  method  in  general, 
it  is  totally  inefficient  in  acute  cases;  but,  like  it,  where  advantage 
is  to  be  derived  from  trusting  to  that  recuperative  power,  which,  we 
have  seen,  is  seated  in  all  living  bodies,  and  is  too  much  neglected, 
its  adoption  is  beneficial.  This  is  one  of  the  useful  lessons,  which 
the  system  aids  in  teaching.  Another,  perhaps,  is,  — the  propriety, 
now  universally  admitted,  of  simplicity  in  our  prescriptions, — in 
consequence  of  the  greater  or  less  uncertainty  that  must  often  exist 

— where  two  or  more  agents  are  thrown  together — - whether  they 
may  not  mutually  modify  each  other’s  action.  The  homoeopathists 
believe,  that  every  disease  carries  with  it  a greater  susceptibility  for 
the  proper  medicine  ; and  accordingly,  they  lay  down  the  rule,  that 
only  one  simple  medicine  should  be  administered  to  the  sick  at  a 
time. 

One  of  the  strangest  of  the  assertions  of  Hahnemann  and  his  fol- 
lowers is  — that  homoeopathic  medicines  acquire  at  each  division  or 
dilution  a new  degree  of  power,  by  the  rubbing  or  shaking  to  which 
they  are  subjected,  a means,”  says  Hahnemann,  of  developing 
the  inherent  virtues  of  homoeopathic  medicines  that  was  unknown  till 
my  tim.e  ; and  which  is  so  energetic,  that  latterly  I have  been  forced^ 
by  experience^  to  reduce  the  number  of  shakes  to  two^  of  which  I for- 
merly prescribed  ten  to  each  dilution’’'*  ! 

Such  are  the  chief  modes  in  which  medicinal  agents  exert  their 
influence  on  the  human  economy. 

I.  Their  agency  may  be  altogether  direct  or  local. 

II.  It  may  be  general  — through  local  influence. 

1.  By  means  of  the  nerves. 

2.  By  absorption. 

3.  By  revulsion. 


^ Hahnemann’s  words  are,  “ dass  ich  in  den  letzern  Jahren  durch  iiberzeugende 
Erfahruiiff  genbthigt  ward,  die  ehemals  vorgeschriebenen  zehn  j^chiittelschlage  nach 
jeder  Verdlinnung  bis  auf  zivei  einzuschranken. — Organon  tier  Heilkunst,  § 280. 


88 


ACTION  OF  MEDICINES. 


2.  CLASSIFICATION  OF  MEDICINES. 

The  unbounded  credulity,  which  at  one  time  prevailed  regarding 
the  effects  of  drugs,  and  which  so  long  disfigured  the  science  of  me- 
dicine, has  now  almost  passed  away,  and  we  observe  less  and  less 
of  the  old  feeling  of  confidence  in  the  adaptation  of  particular  drugs 
to  particular  cases  of  disease.  The  practice  has  become  more  ra- 
tional ; and  efficacious  agents  are  now  mainly  relied  on.  Still  many 
superfluities  exist  in  the  lists  of  the  materia  medica,  which  might, 
with  much  propriety,  be  dispensed  with  ; and  time  will  accomplish 
this.  The  plan  now  is,  — to  discover  the  seat  and  nature  of  the 
diseased  action,  and  to  adapt  a remedy,  whose  properties  are  known, 
to  the  exigency  ; — locally  or  generally ^ as  the  case  may  require. 
We  have  no  agents,  that  are  possessed  of;  specific  properties,  which 
are  exerted  with  unvarying  uniformity  on  disease.  Their  action  is 
modified  by  numerous  circumstances.  A cathartic  may,  in  one  case, 
excite  emesis  in  place  of  catharsis  ; and,  in  another,  an  emetic  may 
excite  catharsis  rather  than  emesis  ; whilst  the  words  febrifuge^  an- 
tispasmodic,  &c.,  are  mere  terms  to  express  the  secondary  result  of 
some  agent  on  the  vital  solid.  It  is  in  consequence  of  medicines 
possessing  no  — no  uniform  — influence,  that  so  much  skill 

and  attention  are  required  in  the  treatment  of  disease.  At  one  time, 
it  was  supposed  that  certain  drugs  are  specifically  adapted  to  com- 
bat certain  morbid  conditions,  but  the  belief,  except  with  the 
homcBopathists,  is  now  exploded,  and  even  mercury  — the  panacea 
of  some — is  denied  to  possess  any  such  power,  and  its  action  is 
more  rationally  accounted  for.  From  what  has  been  said,  it  will 
appear,  that  although  we  may  be  perfectly  acquainted  with  the  ordi- 
nary medicinal  properties  of  a drug,  and  although  these  properties 
may  be  essentially  the  same,  the  agency,  exerted  by  it,  may  be  dif- 
ferent according  to  the  precise  character  of  the  disease,  and  accord- 
ing to  the  age,  sex,  temperament,  &c.,  of  the  patient.  Were  these 
points  determinate,  we  could  always  calculate  with  certainty  what 
would  be  the  precise  action  of  any  medicinal  agent. 

With  regard  to  the  parts  of  the  frame  on  which  medicines  act,  we 
may  affirm,  that  they  are  capable  of  affecting  every  tissue  and  every 
function  — directly  or  indirectly.  Like  other  influences,  which  sur- 
round the  body,  and  are  perpetually  impressing  it  in  some  mode  or 
other,  remedial  agents  can  act  upon  the  living  organs  so  as  to  mo- 
dify every  function.  Ultimately,  however,  they  must  all  affect  the 
same  great  vital  property  of  contractility,  irritability,  incitability,  or 
excitability,  whichsoever  we  may  term  it,  which  is  seated  in 
every  living  tissue.  Under  the  influence  of  this  vital  property,  kept 
in  action  by  appropriate  stimuli,  all  the  functions  are  accomplished, 
and  when  these  stimuli  are  at  a certain  degree,  they  are  accom- 
plished in  health  ; but  if,  from  any  cause,  the  vital  force  becomes 
exalted  or  depressed  beyond  the  healthy  standard,  disease  results; 
and  such  disease  is  a disease  of  increased  or  of  diminished  action. 


CLASSIFICATION  OF  MEDICINES. 


89 


All  medicinal  agents,  which,  in  this  way,  exalt  the  vital  activity  of 
the  body,  are  excitants  ; and  such  as  diminish  it  are  sedatives ; and 
we  may,  consequently,  with  propriety,  class  all  agents,  that  are  use- 
ful, or  that  are  not  wholly  inert,  either  as  excitants  or  as  sedatives. 
The  subject  of  the  classification  of  medicinal  agents  will,  however, 
require  a little  farther  consideration. 

The  advantages  of  classification  in  science  are  obvious.  The  re- 
lations of  articles  to  each  other  are,  in  this  way,  exhibited,  so  as  to 
impress  the  memory,  and  to  facilitate  the  investigations  of  the  stu- 
dent ; but  in  no  branch  of  science  is  it  applicable  under  more  diffi- 
culties than  in  Therapeutics,  provided  we  are  desirous  of  establish- 
ing such  classification  on  the  precise  operation  of  medicinal  agents ; 
whilst  nothing  is  more  easy  than  to  form  a natural  classification  of 
them,  founded  simply  on  the  three  great  kingdoms  of  nature 
to  which  they  may  belong.  Both  these  modes  of  classification, 
termed  respectively  the  Therapeutical  and  the  JYatural  Historical^ 
have  been  detailed  in  all  their  varieties  in  recent  works  on  Ma- 
teria Medica  and  Therapeutics.  The  classifications  of  medicinal 
agents,  based  on  their  operation,  are  numerous,  and,  at  the  same 
time,  most  unsatisfactory.  Immense  labour,  and,  of  course,  valua- 
ble time,  have  been  spent  upon  the  subject,  without  any  rich  fruit. 
It  has  been  already  said,  that  all  remedial  agents,  which  are  pos- 
sessed of  activity,  must  belong  to  one  of  two  classes,  — stimulants 
or  excitants.^  and  sedatives : we  must  except,  however,  certain  agents, 
whose  efifects  are  purely  chemical  or  mechanical,  or  which  are  not 
employed  to  effect  any  changes  in  the  living  tissue.  Perhaps  the  best 
of  all  classifications  would  be  one  founded  upon  the  agency  exerted 
on  the  different  tissues  ; but  this  arrangement,  in  the  present  state  of 
science,  is  by  no  means  easy;  and,  moreover,  the  action  of  medicines 
is  so  associated  with  certain  terms,  — as  narcotics,  tonics,  sedatives, 
&c.,  employed  to  denote  certain  operations,  which  they  are  esteemed 
capable  of  producing,  that,  to  abandon  them,  would  be  to  throw 
obstacles  in  the  path  of  the  student,  without  the  ultimate  advan- 
tage accruing  to  him,  of  possessing  a better  knowledge  of  the 
modus  operandi  of  medicines,  than  when  a classification,  somewhat 
resembling  those  usually  embraced,  is  adopted.  The  classification  of 
M.  Barbier  is  founded  upon  the  tissues  affected,  but  it  is  extremely  in- 
complete, and  unsatisfactory,  and,  in  consequence  of  the  imprac- 
ticability experienced  by  him  in  grouping  the  various  agents  under 
appropriate  heads,  his  last  unmeaning  division  is,  of  course,  a large 
one. 


8= 


90 


CLASSIFICATION  OF  MEDICINES. 


barrier’s  classification. 


Medicines 


' Which  strengthen  the  tissue  of> 
organs,  " - - 5 

Which  stimulate  the  tissue  of  ) 
organs,  - ) 

Which  relax  the  tissue  of  organs, 
Which  moderate  too  great  ac- } 
tivity  of  organs,  - - 3 

Which  diminish  cerebral  life. 
Which  irritate  the  inner  surface  ) 

\ of  the  intestines,  - ) 

Which  irritate  the  gastro-duo-  ) 
denal  surface  especially,  ^ 
Which  disturb  the  natural  move-  > 
ments  of  the  intestines,  3 
Whose  modus  operandi  is  not 
determined,  or  which  cannot  ! 
be  included  in  the  preceding  ( 
classes,  " " " J 


1 . Tonics. 

2.  Excitants. 

3.  Biffusibles. 

4.  Emollients. 

5.  Temper  ants. 

6.  JYarcotics. 

7.  Purgatives. 

8.  Emetics. 

9.  Laxatives. 

10.  Incertce  sedis . 


One  of  the  most  recent  classifications  — and  the  notice  of  any 
more  would  be  unprofitable  — is  that  of  Dr.  A.  T.  Thomson,  founded 
upon  the  classifications  of  Dr.  Thomas  Young,  and  Dr.  Murray.  It, 
also,  is  liable  to  the  objections,  which  must  apply  to  all  attempts  to 
reduce  the  multitude  of  medicinal  agents  to  any  thing  like  a scientific 
arrangement,  as  well  as  to  others,  which  appertain  to  it  exclusively. 

It  is  as  follows : 


I.  VITAL  AGENTS. 

A.  Influencing  the  body  generally  ; 

a.  — By  operating  directly  upon  the  nervous  system. 

* Increasing  action^  . . - - Excitants. 

r n ' -I  ^ Sedatives. 
L Primarily,  ’ 

**  Diminishing  action,  < 

, ( Secondarily, 


b. — On  the  Muscular  and  Sanguiferous  systems: 


I Refrigerants. 

^ Narcotics. 

I Antispasmodics. 


c. — On  the  Secerning  system  : 


Tonics. 

Astringents. 

Errhines. 

Sialagogues. 

Expectorants. 

Emetics. 

Cathartics. 

Diuretics. 

Emmenagogues. 

Diaphoretics. 


CLASSIFICATION  OF  MEDICINES. 


91 


B. — Influencing  the  body  solely  by  their  action  on 
the  part  to  which  they  are  applied, 

Epispastics. 

a.  Rubefacients. 

b.  Vesicants. 

c.  Actual  cauterants. 

II.  CHEMICAL  AGENTS. 

A. — Influencing  the  state  of  the  body,  or  its  con- 
tents, by  their  chemical  properties. 

* Acting  on  the  surface^  - - - Escharotics. 

a.  Potential  cauterants. 

**  On  the  contents  of  cavities. 


III.  MECHANICAL  AGENTS. 

Demulcents. 

Diluents. 

To  the  three  great  divisions  of  Dr.  Thomson  no  objection  need  be 
urged ; but  when  the  different  subdivisions,  and  the  ascribed  modus 
operandi  of  many  of  the  classes  are  considered,  much  room  is  found 
for  difference  of  sentiment.  It  may  be  observed  by  anticipation, 
that  there  is  no  adequate  ground  for  placing  Excitants  among  those 
agents  that  operate  directly  on  the  nervous  system ; and  Tonics 
amongst  those  that  act  on  the  muscular  and  sanguiferous  systems ; 
nor  is  it  readily  seen,  how  Epispastics  can  be  regarded  as  the  only 
agents,  that  influence  the  body  solely  by  their  action  on  the  part  to 
which  they  are  applied.  The  class  of  Anthelmintics ^ which  could 
not  have  fallen  conveniently,  under  any  of  Dr.  Thomson’s  subdi- 
visions — with  the  views,  which  he  probably  entertains  of  the  mode, 
in  which  their  therapeutical  agency  is  exerted  — has  been  wholly 
omitted  ; and  although  anthelmintic  virtues  are  assigned  to  the  ordi- 
nary medicinal  agents,  that  are  conceived  to  possess  such  virtues, — 
when  these  agents  are  referred  to  under  other  heads, — it  is  singular, 
that  the  class  is  neither  mentioned  in  the  table,  nor  in  the  body  of 
the  work.  It  seems  to  have  altogether  escaped  Dr.  Thomson’s  at- 
tention. 

To  the  following  classifications  of  the  author,  objections  may 
doubtless  be  urged.  He  has  already  said,  that  it  is  impracticable  to 
form  any,  which  can  be  altogether  unobjectionable.  It  has  been 
more  than  once  remarked,  that  all  agents,  capable  of  affecting  the 
vital  tissue  so  as  to  modify  its  functions  effectively,  may  be  classed 
under  the  head  of  excitants^  or  of  sedatives.  But,  in  addition  to 
these  — what  may  be  called  — vital  agents  f there  are  some  other 
classes  of  medicines,  which,  in  consequence  of  their  effect  being 
almost  purely  chemical,  without  modifying  the  condition  of  the  living 


Antacids. 
Antalkalies. 
a.  Antiseptics. 
Antilithics. 


92 


CLASSIFICATION  OF  MEDICINES. 


tissue,  maybe  appropriately  designated  chemical  agents  ; and,  ao-ain, 
there  is  one  other  class  equally  without  direct  influence  on  the  vital 
manifestations,  and  acting  simply  or  chiefly  on  the  mass  of  humours  — 
which  may  be  properly  ranked  under  the  denomination  of  mechanical 
agents.  This  is  probably  as  simple  a classification  as  can  be  made, 
and  one  altogether  intelligible  to  the  student.  It  does  not  involve 
questions  connected  with  the  intimate  modus  operandi^  which  must 
necessarily  engage  attention  in  considering  the  different  classes, 
whilst  it  embraces  some  classes  not  admitted  into  the  arrangement 
of  Thomson,  and  which,  it  will  be  seen,  comprise  some  of  our  most 
useful  medicinal  agents.  The  class  of  Anthelmintics  — in  the  sense 
of — “ medicines,  which  prevent  the  generation  of  entozoa  within 
the  body,”  is  placed  next  to  the  class  of  tonics ; because  the  predis- 
ponent cause  of  their  unusual  multiplication  is  a want  of  tone  of  the 
system  generally,  and  of  the  stomach  in  particular  ; and  if  we  con- 
fine our  attention  to  the  destruction  of  these  parasites  by  true  anthel- 
mintics, or,  in  other  words,  by  agents  directly  destructive  to  entozoic 
life,  we  do  but  little,  — the  most  important  step  being  to  remove 
the  predisposition  to  fresh  generation.  As,  in  the  case  of  intermit- 
tent fever,  the  main  object  of  the  practitioner  is  less  directed  to  the 
condition  of  the  patient  during  the  paroxysms,  than  to  the  preven- 
tion of  their  recurrence. 


I.  Vital 
Agents. 


classification  of 

' therapeutical  Ai 
r 

increasing  ac- 

Excitants, 

tion  generally, ' 

or  locally,  or 

■ 

both. 

^ . r 

diminishing  | 

Sedatives.  < 

action  directly  - 

1 

1 

or  indirectly. 

Excitants  proper. 

Tonics. 

Anthelmintics. 

Astringents. 

Emetics. 

Cathartics. 

Emmenagogues. 

Abortives. 

Diaphoretics. 

Errhines. 

Sialagogues. 

Diuretics. 

Expectorants. 

Sorbefacients. 

Revellents. 

Antispasmodics. 


Narcotics. 


Nauseants. 


CLASSIFICATION  OF  MEDICINES. 


93 


II.  Chemical  Agents. 


f Antacids. 

I Antalkalies. 

) Antilithics. 

[ Disinfectants. 


III.  Mechanical  Agents. 


( Demulcents. 
( Diluents. 


This  was  the  classification  adopted  by  the  author  in  the  first  edi- 
ition  of  his  '‘^General  Therapeutics'*'*  ; but  he  finds  it  more  convenient 
to  embrace  one  that  harmonises  more  with  the  arrangement  adopted 
in  his  Practice  of  Medicine.'*'*  The  different  classes  of  therapeutical 
agents,  and  the  agents  themselves,  will  be  investigated  in  the  fol- 
lowing order : 


1.  Agents  that  affect  prominently  the  alimentary  ^ cShartics 
canal  or  its  contents,  - _ _ 


2.  Agents  that  affect  prominently  the  respiratory 
organs,  ------ 


( Anthelmintics. 
I Expectorants. 


f Errhines. 
j Sialagogues. 

3.  Agents  that  affect  prominently  the  follicular  or  Diuretics, 
glandular  organs,  - - - - | Antilithics. 

[ Diaphoretics. 


4.  Agents  that  affect  prominently  the  nervous 
system, 


Narcotics. 

Tetanies. 

Antispasmodics. 


5.  Agents  that  affect  prominently  the  organs  of  ( Emmenagogues. 


reproduction. 


6.  Agents  that  affect  various  organs,  - 


Parturifacients. 

Excitants. 
Tonics. 
Astringents. 
Sedatives. 
Refrigerants. 
Revellents. 
Eutrophics. 


C Antacids. 

7.  Agents  whose  action  is  prominently  chemical,  < Antalkalies. 

( Disinfectants. 

8.  Agents  whose  action  is  prominently  mecha-  ( Demulcents. 


nical, 


Diluents. 


94 


EMETICS. 


SECTION  I. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  ALIMENTARY  CANAL, 
OR  ITS  CONTENTS. 

I.  EMETTCS. 

Synon.  Vorniloria. 

Definition  of  Emetics  — Nauseants — Their  modus  operandi  — Therapeutical  application 
— Physiology  of  vomiting — Modus  operandi  of  emetics  — Efiects  on  the  stomach, 
and  general  system  — Evils  of  their  too  frequent  employment  — Therapeutical  appli- 
cation of  emetics  — Special  emetics. 

Emetics  have  been  defined  by  M.  Schroff,  agents,  which,  by  the 
excitant  effect  they  produce  upon  the  stomach,  give  occasion  to 
vomiting;”  but  this  definition  is  meager  and  unsatisfactory.  That  of 
Dr.  Paris  is  to  be  preferred:  — “ Substances  which  excite  vomiting, 
independently  of  any  effect  arising  from  the  stimulus  of  quantity,  or 
of  that  occasioned  by  any  nauseous  taste  or  ffavour.” 

The  physiology  of  vomiting  has,  of  late  years  more  especially, 
engaged  the  attention  of  some  of  the  most  accurate  anatomists,  and 
physiologists.  At  one  time,  it  was  universally  conceived,  that  the 
stomach  is  the  main  — indeed,  the  sole  — agent;  whilst,  at  an  after 
period,  the  opposite  view  was  maintained,  and  the  stomach  was 
denied  any  agency  whatever  in  the  result.  The  intimate  consider- 
ation of  this  topic  of  physiology  has  been  gone  into,  in  another  work; 
and  it  is  not  necessary  to  repeat  it  here.  It  may  be  observed,  how- 
ever, that  the  former  of  the  theories  referred  to,  which  prevailed  of 
old,  is  full  of  error,  and  ought  to  be  discarded;  and  that,  as  often 
happens,  when  exclusive  and  hostile  views  are  maintained,  the  truth 
probably  lies  between  them,  or  may.  consist  of  a combination  of  both. 
From  a careful  examination  of  what  has  been  said  on  both  sides  of 
the  question,  it  appears,  that  we  are  justified  in  inferring,  that  the 
stomach,  of  all  the  organs  concerned,  is  the  one  whose  action  is  least 
energetic  and  indispensable;  that  the  pressure,  exerted  on  its  parietes 
by  the  diaphragm,  and  abdominal  muscles,  is  the  most  powerful 
cause:  as,  it  is  found,  that  the  more  or  less  complete  paralysis  of  the 
diaphragm,  or  the  destruction  of  the  abdominal  muscles,  renders 
vomiting  much  more  feeble,  and  more  slow  in  manifesting  itself. 

When  an  emetic  has  been  taken  in  a sufficient  dose,  a train  of 
phenomena  makes  its  appearance  contrasting  greatly  with  those  that 
follow.  An  indescribable  sensation  is  first  of  all  experienced,  which 
is  chiefly  referred  to  the  region  of  the  stomach,  and  consists  of  a 
feeling  of  anxiety  and  of  circumgyration,  which  extends  also  to  the 
head;  a copious  flow  of  saliva  and  of  sweat  takes  place,  with  pale- 
ness of  the  surface,  and,  indeed,  every  sign  of  diminished  nervous 
and  vascular  action.  This  state  of  ‘‘nausea,”  as  it  is  termed,  is 
manifestly  one  of  debility,  or  of  diminution  of  the  vital  powers;  and, 
when  it  has  continued  for  any  length  of  time,  is  usually  succeeded 


NAUSEANTS. 


95 


by  a very  (lifTerent  condition  of  the  functions;  the  diaphragm  and 
abdominal  muscles  are  thrown  into  violent  contraction;  an  inverted 
action  of  the  muscular  coat  of  the  stomach  is  produced;  and,  under 
these  combined  actions,  the  contents  of  the  stomach  are  ejected. 
During  this  state  of  excited  action,  the  pulse  assumes  fresh  vigour: 
the  skin  becomes  florid,  especially  that  of  the  face;  a copious,  warm 
perspiration  takes  the  place  of  the  cold,  clammy  sweat  of  nausea, 
and  all  is  energy  where  depression  previously  prevailed. 

It  is  obvious,  then,  that  the  therapeutical  effects  of  substances, 
capable  of  exciting  emesis,  must  vary  according  as  they  are  adminis- 
tered to  keep  up  nausea,  or  given  in  doses  sufficient  to  induce  emesis ; 
and,  again,  that  emetics  may  differ  amongst  themselves  according  as 
their  operation  is  preceded  or  not  by  more  or  less  nausea. 

Where  the  nauseant  operation  is  alone  induced,  the  effects  of  the 
remedy  are  so  different  as  to  demand  a separate  consideration. 

I.  NAUSEANTS. 

The  state  of  nausea  being  one  of  reduced  action,  it  can  be  readily 
understood,  that  a sedative  agency,  thus  induced,  and  kept  up  for  a 
sufficient  length  of  time,  may  succeed  in  subduing  inflammation,  and 
the  morbid  exaltation  of  organic  actions  which  constitutes  ordinary 
fever.  These  effects  can  be  accomplished  by  nauseating  remedies 
properly  administered. 

From  the  effects,  then,  which  nauseantS  are  capable  of  inducing, 
their  therapeutical  application  will  be  sufficiently  obvious,  and,  ac- 
cordingly, but  little  difficulty  is  experienced  by  the  practitioner  in 
laying  down  his  indications,  or  in  carrying  them  into  effect,  by  some 
one  or  more  of  the  numerous  nauseants,  which  are  contained  in  the 
catalogues  of  the  materia  medica. 

With  regard  to  the  condition  of  the  functions  under  the  influence 
of  a nauseant,  — when  pushed  to  the  extent  of  inducing  marked 
nausea,  — there  can  be  no  difference  of  opinion  ; but  it  has  been  a 
question,  whether,  if  these  same  agents  be  given  so  as  to  fall  short 
of  inducing  nausea,  or  any  sensible  evidences  of  their  action, — in 
alterative  doses,  in  other  words,  — they  may  not  modify  the  functions 
in  the  same  manner  as  full  nauseants,  but  to  a less  degree. 

A great  deal  may  be  said  in  favour  of  the  affirmative  view  of  this 
question,  but  it  is  one  obviously  not  easy  of  demonstration.  Were 
we,  indeed,  to  deny  the  position  altogether,  it  would  be  difficult  to 
account  satisfactorily  for  the  operation  of  antimonials,  or  of  many 
other  reputed  diaphoretics  in  small  doses,  which  are  emetic  in  larger. 

All  admit,  that  when  the  tartrate  of  antimony  and  potassa  is  given 
so  as  to  produce  nausea,  it  is  a decided  sedative  and  diaphoretic,  — 
diaphoretic  because  sedative.  The  state  of  nausea  being,  as  already 
remarked,  one  of  diraished  action,  — the  exalted  vital  manifestations, 
constituting  fever,  are  reduced  by  it ; and  diaphoresis,  which  had 
been  checked  by  the  febrile  irritation,  is  restored.  In  this  case,  the 
antimonial,  — like  every  diaphoretic,  — is  an  indirect  agent  only. 


96 


EMETICS. 


]3ut  if  the  tartrate  of  antimony  and  potassa  be  given  in  doses  some- 
what smaller  than  are  requisite  to  induce  nausea,  it  can  still  be  con- 
ceived, that  an  action  of  sedation  may  be  exerted,  although,  it  must 
be  confessed,  that  we  have  no  sensible  evidence  of  such  an  effect 
except  the  result  ; and,  it  must  be  equally  confessed,  that,  in  our 
uncertainty,  we  ought  scarcely  to  place  that  confidence  in  those 
agents,  which  is  occasionally  reposed  in  them  by  practitioners. 
Fortunately,  however,  — as  remarked  under  another  section,  in  re- 
gard to  antimonials  especially,  — this  very  confidence  is,  at  times, 
followed  by  negatively  beneficial  results.  It  prevents  the  partisans 
of  the  perturbating  treatment  of  fever  by  means  of  violent  and  re- 
peated cathartics  from  causing  as  much  irritation  as  they  might  other- 
wise do,  and  gives  the  patient  a little  of  that  quietude  and  absence 
from  disturbance,  which  is  so  important  in  the  management  of  all 
febrile  cases,  and  especially  of  such  as  are  accompanied  by  erethism 
in.  the  mucous  membrane  of  the  intestines. 

Therapeutical  application  of  A^auseants. 

Internal  inflammation. — In  all  internal  inflammations,  nauseants 
are  obviously  proper,  as  well  as  in  every  kind  of  active  hemorrhage  ; 
whenever,  indeed,  it  is  desirable  to  diminish  the  force  and  velocity 
of  the  circulatory  movements.  In  such  cases,  they  are  amongst  our 
most  valuable  therapeutical  means,  and,  if  the  system  can  be  kept, 
for  any  length  of  time,  sufficiently  under  their  influence,  the  local 
hypersemia  will  often  yield,  after  it  has  resisted  other  agencies.  In 
a case  of  pericarditis,  which  fell  under  the  author’s  care,  and  which 
threatened  fatal  results,  the  acetate  of  morphia  was  administered 
in  a full  sedative  dose  ; — this  salt  being  preferred  to  opium  in  con- 
sequence of  the  latter  disagreeing  in  the  particular  case.  The  nau- 
sea, caused  by  it,  was  intense  ; but  the  symptoms  were  so  much  ame- 
liorated, that  the  dose  was  repeated  : in  this  way,  the  nausea  was 
kept  up  for  forty-eight  hours,  and,  during  the  condition  of  sedation, 
the  inflammatory  signs  disappeared,  and  the  patient  doubtless  owed 
her  safety  mainly  to  the  nauseant  agency. 

Constipation.  — In  constipation,  a union  of  nauseants  with  cathar- 
tics becomes  occasionally  advisable,  and  at  times  effectual,  after 
cathartics  alone  have  been  unsuccessfully  employed.  If  the  con- 
stipation be  dependent  upon  any  irritated  condition  of  the  exhalants 
of  the  canal,  the  use  of  debilitants,  — such  as  those  now  under  con- 
sideration, — reduces  the  erethism,  and  facilitates  the  operation  of 
the  purgative.  Whenever,  too,  it  is  desirous  to  break  in  upon  a 
morbid  chain,  and  especially  in  the  neuroses,  nauseants  may  be 
beneficially  administered : but,  in  these  cases,  the  revulsion,  induced 
by  a nauseating  emetic,  is  generally  preferred,  in  consequence  of  the 
more  powerful  impression  which  it  makes  on  the  nervous  system. 
This  subject  will,  however,  be  fully  canvassed,  under  the  heads  of 
Emetics,  and  Revellents  respectively.  The  practitioner  has,  in  all 


NAUSEANTS. 


97 


cases,  to  reflect,  whether  the  state  of  the  organic  actions  be  such  as 
to  require  the  debilitant  agency,  which  nauseants  are  capable  of 
exerting  ; and  it  is  not  generally  difficult  to  arrive  at  a correct  con- 
clusion. Perhaps,  in  all  cases,  the  tartrate  of  antimony  and  potassa 
is  capable  of  fulfilling  every  desire  of  the  physician  ; but,  occasion- 
ally, other  articles  are  selected  : — ipecacuanha  by  some  ; squill  — 
particularly  when  the  affection  is  seated  in  the  air  passages  — by 
others  ; but  there  is  not  sufficient  reason  for  the  belief,  that  any  nau- 
seant  is  preferable  to  the  tartrate  of  antimony  and  potassa  ; and, 
moreover, — being  devoid  of  any  stimulating  property,  — it  can  be 
administered  in  many  cases,  in  which  the  exciting  emetics  would  be 
obviously  improper. 

Surgical  cases.  — With  similar  views  to  those  that  impress  the 
physician,  the  surgeon  has  recourse  to  nauseants.  Whenever  it  is 
desirable  to  depress  the  energies  of  the  system,  and  to  induce  re- 
laxation of  constricted  parts,  they  are  advantageously  employed.  In 
strangulated  hernia.^  tobacco  smoke,  or  tobacco  infusion  is  thrown 
into  the  rectum  ; but,  as  will  be  shown  hereafter,  the  use  of  tobacco, 
even  in  this  form,  is  not  devoid  of  danger;  and,  perhaps,  there  is  no 
relaxant  effect  produced  by  it,  which  might  not  be  equally  produced 
by  the  nauseants  above  mentioned. 

When  a luxated  limb  has  to  be  reduced,  the  force  of  contraction 
of  the  muscles  is  diminished  during  the  existence  of  nausea  ; and 
if  the  surgeon,  at  the  time,  employs  his  manoeuvres  dexterously,  he 
may  succeed  in  effecting  the  reduction. 

Obstetrical  cases.  — To  the  obstetrical  practitioner  nauseants  are 
not  less  useful.  When  tartar  emetic  is  given  so  as  to  impress  the 
system,  it  removes  rigidity  of  the  os  uteri ; and  in  violent  or  irrita- 
ble labour  the  inordinate  activity  of  the  uterus  is  allayed  by  it, 
whilst  the  dilatation  of  the  mouth  of  the  organ  is  facilitated.  Dr. 
Kennedy,  of  Dublin,  has  drawn  the  attention  of  practitioners  to 
these  cases,  as  well  as  to  the  value  of  nauseants  in  puerperal  con- 
vulsions, in  obstructed  and  inflamed  mammae,  and  in  puerperal  ma- 
nia; but  it  is  needless  to  attempt  to  point  out  every  affection,  in 
which  nauseants  may  be  employed  with  advantage.  By  bearing  in 
mind  the  sedative  influence  they  are  capable  of  exerting,  the  prac- 
titioner can  meet  with  little  difficulty  in  deciding  upon  the  cases  in 
which  their  exhibition  may  be  noxious  or  salutary. 

II.  EMETICS. 

In  order  that  an  emetic  shall  produce  its  effect  upon  the  stomach, 
it  must  first  of  all  affect  the  brain.  Should  it  irritate  the  nerves  of 
the  stomach,  that  irritation  must  be  appreciated  by  the  brain,  and  a 
reflex  action  be  exerted  upon  the  stomach,  before  it  can  discharge 
its  contents.  It  is  not  necessary,  however,  that  the  impression  should 
VOL.  I. — 9 


98 


EMETICS. 


be  first  made  on  the  gastric  nerves.  Certain  sources  of  irritation, 
seated  elsewhere,  may  impress  the  brain  by  their  irradiations,  and 
produce  the  same  effect. 

Various  circumstances  affecting  the  nerves  of  the  stomach  may 
excite  vomiting;  — for  example,  the  administration  of  substances 
belonging  to  the  class  of  emetics  ; over-distention  of  the  organ  ; 
offensive  character  of  food  ; morbid  secretions  from  the  supra-dia* 
phragmatic  portion  of  the  alimentary  canal,  or  from  the  stomach 
itself;  reflux  of  bile  into  the  stomach,  &c.  &c.  In  these  cases,  the 
impression  is  made  upon  the  nerves  of  the  stomach  ; thence  it  passes 
to  the  brain,  which  appreciates  the  sensation,  and  calls  upon  the  dif- 
ferent organs,  concerned  in  vomiting,  to  execute  their  functions. 

But  numerous  cases  present  themselves,  in  which  the  impression 
is  first  received  on  other  parts  than  the  stomach,  and  where  it  equally 
proceeds  to  the  brain,  which  then  calls  for  the  action  of  the  appro- 
priate organs.  Thus,  the  stomach  sympathises  with  an  organ,  that 
has  been  long  suffering  under  chronic  irritation : there  is,  indeed, 
scarcely  an  organ  in  the  body,  which,  when  affected  with  protracted 
suffering,  does  not  disorder  the  functions  of  the  stomach,  and  in- 
duce vomiting.  The  irritation  of  the  uvula,  when  elongated  ; and 
the  presence  of  tenacious  phlegm  in  the  posterior  nares,  bring  on  a 
kind  of  “ gagging, which  is  occasionally  followed  by  full  vomiting. 
We  have  examples,  also,  in  which  the  nervous  impression  is  even 
more  remotely  connected  with  the  effects  than  in  those  selected. 
The  sight  of  a disgusting  object  will  “ turn  the  stomacli’’^  of  many. 
The  same  may  be  said  of  nauseous  smells,  and  flavours;  of  riding, 
sailing — especially  at  sea,  swinging,  &c.  In  all  these  cases,  the 
impression  is  made  on  the  nerves, — the  great  nervous  centres  being 
primarily  or  secondarily  affected.  Did  it  indeed  admit  of  the  slightest 
question,  that  the  encephalon  must  always  be  implicated  in  the  act 
of  vomiting,  the  circumstance,  that  if  its  impressibility  be  blunted 
by  narcotics,  it  is  excessively  difficult  to  excite  vomiting,  — a fact 
which  has  to  be  borne  in  mind  when  the  therapeutist  is  called  upon 
to  act  in  cases,  where  narcotics  have  been  taken  as  poison,  — would 
tend  to  establish  the  affirmative. 

In  many  cases,  the  effect  of  an  emetic  agency  — although  appa- 
rently produced  with  inconceivable  rapidity  — must  be  the  result  of 
a very  complex  and  reflex  operation.  When,  for  instance,  pain  in 
a distant  organ  sickens,  the  brain  must  accomplish  the  sensation  ; 
thence  a reflex  action  must  take  place  to  every  part  of  the  surface  of 
relation,  and  the  gastric  nerves  be  specially  impressed,  and  call  on 
the  brain,  to  send  the  nervous  influx  to  the  organs  particularly  con- 
cerned in  the  act  of  vomiting. 

When  vomiting  has  continued  for  some  time,  accompanied  by  vio- 
lent retching,  more  or  less  bile  is  always  evacuated  ; — the  inverted 
action  of  the  stomach  being  extended  to  the  duodenum ; and  the 
irritation  produced  in  the  alimentary  canal,  being  propagated  along 
the  biliary  ducts  to  the  liver,  so  that  the  secretion  from  it  becomes 


GENERAL  EFFECTS. 


99 


augmented.  It  is  a common  belief,  that  where  bile  is  discharged 
during  vomiting,  excited  in  this  or  in  any  other  way,  it  is  a proof,  that 
the  person  is — what  is  termed  — ‘‘  bilious, but,  for  the  reasons  that 
have  just  been  assigned,  it  may  be  no  more  than  an  evidence  that 
emesis  has  taken  place  with  retching.  At  times,  in  violent  mis- 
chief affecting  the  intestinal  canal — as  in  cases  of  colica  ileus — the 
inverted  action  extends  even  as  low  down  as  the  large  intestine ; the 
faeces  are  made  to  clear  the  ileo-caecal  valve,  and  are  discharged  by 
the  mouth,  giving  rise  to  the  alarming  phenomenon  of  stercoraceous 
vomiting ; but  this  never  occurs  from  the  administration  of  any 
emetic.  It  is  always  an  index  of  serious  lesion  or  obstruction  of  the 
intestinal  tube. 

The  action  of  an  emetic  is  local  as  regards  the  stomach,  but  it  ex- 
tends to  almost  every  organ  of  the  body.  It  has  been  already  said, 
that  its  effect  is  that  of  an  excitant  to  the  nervous  and  sanguiferous 
systems,  causing  the  blood  to  circulate  more  freely  through  the  capil- 
lary vessels  ; and  in  this  way  trifling  obstructions  may  be  removed  ; 
but  if  the  obstruction  amounts  to  hypereemia,  and  especially  if  this 
latter  condition  exists  to  any  great  extent,  it  may  be  increased  by  it. 
In  all  the  varieties  of  hypersemia,  that  characterise  local  inflammation, 
there  is,  as  the  author  has  attempted  to  show,  an  over-distended  and 
atonic  condition  of  the  extreme  vessels,  induced  by  the  blood  having 
been  sent  into  them,  under  some  source  of  irritation,  in  undue  quan- 
tity. This  over-distended  state  of  capillaries  gives  occasion  to  re- 
mora of  blood  in  them,  and  excites  the  vessels,  communicating  with 
them,  to  inordinate  action  ; and  it  is  obvious,  that  if,  in  such  a state, 
a remedial  agent  be  administered,  whose  effect  is  to  hurry  the  circu- 
latory fluid  towards  the  affected  parts,  the  hypereemia  may  be  aug- 
mented. Accordingly,  it  might  be  supposed,  that  emetics  would  act 
injuriously,  when  any  of  the  internal  organs  are  labouring  under  in- 
flammation. This  would  seem,  indeed,  to  be  a general  principle  of 
therapeutics,  and  to  be  especially  applicable  to  inflammation  of  those 
viscera,  which  are  more  particularly  affected  in  a mechanical  manner 
during  the  operation  of  vomiting ; but  exceptions  can  be  readily 
imagined,  or  rather,  there  may  be  modifying  circumstances,  which 
may  be  urged  against  its  universality.  In  active  inflammation,  for 
example,  there  is  more  or  less  concentration  of  the  vital  energy  to- 
wards the  inflamed  part ; but  the  effect  of  the  operation  of  an  emetic 
is  to  propel  the  blood  towards  every  organ  of  the  body,  and  thus  to 
equalise  the  circulation. 

There  is,  too,  another  effect  of  emetics,  which  enables  us  to  produce 
positively  beneficial  results  in  internal  inflammations  of  organs  not 
immediately  concerned  in  the  act  of  vomiting  ; this  is  the  revulsive  — 
one  of  the  most  important,  indeed,  of  therapeutical  agencies.  The 
stomach,  and  the  organs  more  immediately  concerned,  are,  in  this 
way,  made  the  centre  of  an  artificial  fluxion,  which  detracts  from  that 
existing  in  some  other  portion  of  the  organism.  Under  this  joint 
equalising  and  revulsive  agency,  emetics  are  beneficially  employed 


100 


EMETICS. 


in  certain  inflammatory  affections,  notwithstanding  their  tendency  to 
add  to  the  hypersemic  condition  ; — the  good,  effected  by  the  equalis- 
ation and  revulsion,  largely  preponderating  over  the  injurious  ten- 
dency in  question. 

During  the  efforts  of  vomiting,  the  abdominal  viscera  are  com- 
pressed by  the  contraction  of  the  diaphragm  and  abdominal  muscles; 
hence  the  different  secretions,  which  take  place  from  them,  are  aug- 
mented ; and  a tendency  to  displacement  is  communicated,  so  that 
hernial  protrusions  may  be  produced,  — or  increased,  if  already  exist- 
ing. The  different  procidentias,  too,  of  the  pelvic  viscera  are  inju- 
riously affected  by  the  pressure,  and  if  the  female  be  impregnated, 
abortion  may  be  occasioned  : indeed,  there  are  certain  obstetrical 
physiologists,  who  think,  that  the  extrusion  of  the  child,  in  parturi- 
tion, is  altogether  accomplished  by  the  contraction  of  the  abdominal 
muscles,  — a position,  which  would  not  appear  to  be  tenable.  By 
placing  the  hand  on  the  abdomen  during  one  of  the  violent  throes  of 
labour,  that  viscus  can  be  felt  contracting  energetically  ; can  be  seen, 
indeed,  to  do  so,  where, — as  in  France, — the  clothes  are  thrown 
up  about  the  termination  of  labour,  in  order  that  the  elhves  may  have 
an  opportunity  of  inspecting  the  phenomena  connected  with  man’s 
ingress  into  the  world.  Were  it  otherwise,  there  would  seem  to  be 
no  necessity  for  the  development  of  muscular  fibres,  which  is  found 
to  take  place  as  the  uterus  becomes  distended  in  utero-gestation. 

In  the  efforts  of  vomiting,  the  circulation,  as  above  remarked,  be- 
comes hurried,  so  that  evil  might  result  in  those,  who  are  labouring 
ander  aneurismal  or  other  serious  lesions  of  the  heart  and  arteries  ; 
and  instances  are  on  record,  where  the  vessels  have  given  way  during 
retching.  The  circulation  through  the  lungs,  as  in  every  other  part 
of  the  frame,  becomes  augmented  in  velocity ; the  secretions  from 
the  bronchial  tubes  are  rendered  more  copious,  and  hence  an  emetic 
becomes  an  expectorant  — an  agent  whose  modus  operandi  will  be 
inquired  into  hereafter.  This  effect  is  not  facilitated  in  the  man- 
ner mentioned  only.  An  additional  force  is  invoked.  The  succussion 
communicated  to  the  lungs,  by  the  repeated  contraction  and  relaxa- 
tion of  the  diaphragm  during  vomiting,  not  only  increases  the  secre- 
tion, but  dislodges  it  when  secreted,  so  that  it  becomes  loose  and 
more  readily  expelled  by  coughing.  Hence  it  happens,  that  a hard, 
and  dry  cough  is  converted  into  one  that  is  loose,  and  free. 

In  the  accelerated  action  of  the  larger  organs  of  circulation,  pro- 
duced by  vomiting,  the  capillary  vessels  participate  ; and  a copious 
and  warm  perspiration  usually  supervenes,  contrasting  singularly 
with  the  cold,  clammy  perspiration  of  nausea.  Hence  emetics  be- 
come diaphoretics. 

As  to  their  effect  on  the  stomach  itself,  they  may  simply  evacuate 
its  contents,  which  may  consist  of  food  taken  in,  with  the  secretions 
from  the  supra-diaphragmatic  portion  of  the  tube  as  well  as  from  the 
stomach  itself.  At  times,  these  last  secretions  are  morbid,  and  unless 
they  are  removed,  they  may  become  the  source  of  irritation,  khis  is 


GENERAL  EFFECTS. 


101 


especially  the  case  in  diseases  accompanied  with  great  erethism  of 
the  dermoid  tissue.  Whenever  the  cutaneous  surface  is  extensively 
excited, — as  indicated  by  great  heat  or  by  efflorescence,  — the  mu- 
cous membrane  lining  the  stomach  is  apt  to  participate  in  the  irrita- 
tion, so  that  secretions  of  a morbid  character  take  place  from  it : these 
secretions  can  be  readily  removed  by  the  action  of  a gentle  emetic. 
It  is  easy  to  see,  however,  that,  under  the  stimulation  produced  by 
emetics  of  powerful  action,  the  lining  membrane  of  the  stomach  must 
be  more  or  less  excited,  and  hence,  a copious  secretion  of  the  mu- 
cous fluid  takes  place ; mucus  is  observed  to  be  mixed  with  the 
rejected  matters,  and,  for  the  reasons  already  assigned,  bile  is  gene- 
rally present.  But,  if  substances  too  irritating,  or  too  violent  in  their 
action,  be  administered,  the  membrane  may  become  inflamed  and 
true  gastro-enteritis  result.  It  has  been  properly  remarked  by  M. 
Broussais,  that  the  specific  character  of  emetics  and  purgatives  is 
merely  stimulation,  which  may  terminate,  if  the  dose  be  very  large, 
in  inflammation  and  ulceration  of  the  digestive  mucous  membrane. 
The  same  author  has  well  said,  too,  that  the  long-continued  employ- 
ment of  stimulants  — as  emetics  — greatly  exalts  the  sensibility  of 
the  stomach,  rendering  the  treatment  protracted  and  difficult,  and 
laying  the  foundation  for  repeated  relapses.  Emetics,”  he  remarks, 
‘‘  may  unhesitatingly  be  placed  at  the  head  of  the  causes,  which 
most  promptly  produce  it,”  [exaltation  of  the  sensibility  of  the  sto- 
mach.] We  have  collected  some  very  remarkable  examples  of 
this  kind  of  lesion  in  persons,  who  had  been  made  to  vomit  for  many 
hours  by  incessantly  repeated  doses  of  tartar  emetic,  or  to  whom  this 
remedy  had  been  administered  for  many  days  in  succession.  It  is 
seldom  after  such  errors,  that  the  physician  does  not  observe  in  his 
patients  a permanent  exaltation  of  the  sensibility,  and  irritability  of 
the  stomach.  We  have  at  present  under  our  care,  (August,  1826,) 
a lady,  who  was  subjected  in  1813,  by  her  physician,  to  emesis  for 
three  consecutive  days,  to  cure  a supposed  gastric  oppression.  In 
the  excess  of  his  zeal,  he  thought  it  his  duty  to  remain  constantly 
with  his  patient,  to  make  her  take,  at  stated  periods,  doses  of  tartar 
emetic,  which  he  had  carefully  put  up  himself.  The  very  next  day, 
•^symptoms  of  disorder  in  the  hypochondriac  region  manifested  them- 
selves, with  which  the  lady  had  never  before  been  affected  ; and, 
from  that  period,  it  has  been  impossible,  by  any  means,  to  calm  the 
irritability  of  the  stomach,  or  to  blunt  the  painful  sympathies,  which 
accompany  digestion.  We  have  also  attended  numerous  other  neuro- 
pathic patients,  who  dated  their  disorders  from  repeated  emetics,  ad- 
ministered to  them  by  the  same  physician,  one  of  the  greatest  erne- 
Users  we  know.” 

Full  vomiting,  accompanied  with  much  retching,  or  nervous  con- 
centration on  the  stomach,  promotes  both  exhalation  and  absorption. 
The  cutaneous  transpiration  is  augmented,  as  it  is  in  the  precursory 
state  of  nausea  ; but  the  perspiration,  induced  at  these  two  periods, 
is  essentially  different.  In  the  former  case,  it  is  the  healthy,  ener- 
9* 


102 


emp:tics. 


getic  action  of  vessels,  similar  to  that  which  takes  place  in  rude 
health  under  the  agency  of  exercise  or  external  warmth : in  the  lat- 
ter, the  whole  system  is  labouring  under  temporary  debility;  and 
the  cold  clammy  exudation  sufficiently  exhibits  the  diminished  ac- 
tivity  of  the  vital  forces. 

Absorption  is  affected  by  the  same  class  of  agents ; but,  with 
regard  to  the  precise  mode  in  which  the  result  is  produced  thera- 
peutists differ.  It  cannot  be  because  of  the  augmented  secretion 
which  takes  place  from  the  lining  membrane  of  the  stomach,  for  that 
is  to  a trifling  amount;  — so  trifling,  indeed,  that  it  could  not  be 
expected  from  this  cause,  that  any  unusual  demand  would  be  made 
upon  the  absorbents  of  ajiypart  of  the  system.  We  can  account  for 
absorption  being  more  energetically  exerted,  in  cases  of  dropsy,  for 
example,  after  the  administration  of  agents,  ashydragogue  cathartics, 
which  occasion  a greater  separation  of  the  wmtery  parts  of  the  blood, 
or  after  blood  has  been  taken  from  the  vessels  ; because  here  the 
quantity  of  circulating  fluid  being  diminished  a more  ready  imbibi- 
tion of  the  fluid  of  dropsy  is  effected  ; but  this  explanation  does  not 
well  apply  to  the  operation  of  emetics.  It  will  be  shown  hereafter, 
that  the  nervous  system  is  largely  concerned  in  the  operation  of  cer- 
tain agents  that  modify  the  function  of  nutrition,  and  this  is  probably 
the  case  in  vomiting.  The  powerful  nervous  concentration  on  the 
stomach,  and  the  different  organs  concerned  in  vomiting,  interferes 
probably  with  the  functions  of  nutrition  and  secretion  in  other  parts 
of  the  organism,  so  that  less  fluid  may  be  exhaled,  whilst  that,  which 
has  already  been  deposited,  passes  readily  through  the  coats  of  the 
blood-vessels  by  imbibition,  and  gains  the  fluid  of  the  circulation. 
This  modification  of  nutrition  is  exemplified  in  the  disappearance  of 
morbid  growths  under  the  touch  of  royalty,  the  wand  of  the  magi- 
cian, and  the  incantations  of  the*  impostor. 

From  what  has  been  said,  it  will  be  readily  inferred,  that  emetics, 
like  local  stimulants  in  general,  are  valuable  revellents,  although, 
owing  to  the  powerful  effects  they  produce  on  the  whole  vascular  and 
nervous  system,  they  may  not  be  susceptible  of  such  useful  applica- 
tion as  cathartics,  whose  operation  is  more  circumscribed.  In  head 
affections,  for  example,  whilst  cathartics  are  of  great  advantage  by 
deriving  from  the  encephalon,  and  occasioning  a salutary  excitation 
in  the  lining  membrane  of  the  bowels,  emetics  may  be  of  doubtful 
propriety,  owing  to  the  violence  of  their  operation  forcing  the  blood 
toward  the  encephalon,  and  endangering  the  augmentation  of  any 
hyperaemic  condition,  that  may  be  existent  there.  Still,  in  the  opi- 
nion of  many,  no  mischief,  — but  rather  advantage,  — accrues  in 
those  very  cases  from  the  use  of  emetics. 

Emetics  differ  greatly  in  the  period  that  elapses  between  their  ad- 
ministration and  operation,  and  also  in  the  degrees  in  which  they 
induce  nausea.  The  sulphates  of  zinc  and  copper,  for  example,  act 
speedily  ; whilst  the  tartrate  of  antimony  and  potassa,  or  ipecacuanha, 
requires  fifteen  or  twenty  minutes.  This  fact  has  given  rise  to  a di- 


GENERAL  EFFECTS. 


103 


vision  of  emetics  into  direct  and  indirect^  or  in  other  words,  into  such 
as  are  conceived  to  act  by  impressing  the  nerves  of  the  stomach  pri- 
marily ; and  such  as  exert  their  agency,  in  the  first  instance,  on  the 
great  nervous  centres  themselves. 

An  agent  of  the  first  class  is  presumed  to  excite  such  a disagree- 
able impression  upon  the  nerves  of  the  mucous  coat  of  the  stomach, 
that  the  brain  immediately  calls  for  the  assistance  of  the  different 
muscles  concerned  in  vomiting,  and  the  contents  of  the  stomach  are 
at  once  evacuated  ; or  repeated  efforts  are  instantaneously  established 
to  effect  their  expulsion. 

On  the  other  hand,  an  agent  of  the  latter  class  is  presumed  to  ex- 
cite no  immediately  disagreeable  impression  upon  the  gastric  nerves, 
but  gives  occasion  to  the  act  of  emesis  by  passing  into  the  circula- 
tory apparatus  of  the  stomach  ; impressing  the  nerves  distributed  to 
the  lining  membrane  of  the  blood-vessels ; or  reaching  the  brain, 
and  making  its  first  impression  upon  that  organ  ; and  the  fact  that 
many  substances,  — as  the  tartrate  of  antimony  and  potassa,  — which, 
as  regards  its  agency  on  the  stomach,  is  equally  soluble  with  the 
sulphates  of  zinc  or  copper,  — require  such  a length  of  time  before 
their  effects  are  produced,  compared  with  those  last  salts,  is  favour- 
able to  the  latter  opinion  : only  one  other  view  could  indeed  be 
indulged,  and  it  is  sufficiently  difficult  of  comprehension  ; — that  the 
tartarised  antimony  requires  to  make  a more  protracted  impression 
on  the  gastric  nerves,  than  the  salt  of  zinc  ; yet  how  this  can  be 
effected  by  a solution,  capable  of  such  ready  absorption,  is  by  no 
means  clear. 

The  rapid  emetics,  as  a general  rule,  excite  the  least  nausea,  and 
their  action  is  soonest  over.  The  vegetable  emetics  are  generally 
attended  with  more  nausea  than  the  mineral  ; although  the  tartrate 
of  antimony  and  potassa,  which  requires  about  the  same  time  before 
its  operation  commences,  is  considerably  nauseant,  and  is  more  fre- 
quently employed  to  excite  nausea,  where  such  agency  is  demanded, 
than  any  other  substance  belonging  to  the  class.  The  effects  of  sub- 
stances, which  require  time  for  action,  supervene  more  gradually, 
and  continue  longer.  As  a general  rule,  too,  the  rapid  emetics  are 
not  productive  of  much  retching,  when  compared  with  the  others ; 
and  hence  a judicious  selection  of  a particular  emetic  for  a special 
morbid  condition,  or  to  fulfil  a certain  indication,  may  be  important. 
Where  the  object  is  simply  to  evacuate  the  contents  of  the  stomach, 
a rapid  emetic,  and  one  that  is  neither  accompanied  in  its  action 
with  nausea  nor  retching,  is  indicated.  On  the  other  hand,  where  a 
powerful  nervous  impression  has  to  be  made,  one  of  an  opposite  cha- 
racter is  demanded.  Hence  it  is,  that  if  a noxious  substance  be 
taken  into  the  stomach,  recourse  is  had  to  the  sulphate  of  zinc  or 
the  sulphate  of  copper  ; whilst,  in  an  attack  of  intermittent,  where 
we  are  desirous  of  powerfully  impressing  the  nervous  system,  the 
tartarised  antimony,  or  ipecacuanha,  or  a combination  of  both,  is 
selected. 


104 


EMETICS 


When  an  emetic  is  given  for  the  purpose  of  simply  evacuating  the 
contents  of  the  stomach  in  disease,  fluid  — as  warm  water,  or  warm 
chamomile  tea,  or  mustard  and  water,  or  a few  drops  of  solution  of 
ammonia  in  water  — may  be  used,  especially  after  each  act  of 
vomiting,  for  the  purpose  of  preventing  retching.  The  fluid  must, 
however,  be  allowed  in  moderation,  and,  where  a soluble  poisonous 
article  has  been  taken,  but  little  should  be  permitted,  unless  it  can 
be  removed  from  the  stomach  by  the  stomach-pump  immediately 
after  it  has  been  swallowed,  or  is  likely  to  be  evacuated  at  once 
under  the  action  of  an  emetic.  Hence,  dry  vomiting  is  advised  in 
such  cases.  Where  the  tartrate  of  antimony  and  potassa  is  adminis- 
tered to  children  as  an  emetic,  it  may  be  well  to  allow  the  child  to 
suck  or  drink  before  the  operation  comes  on,  as  the  salt,  it  is  asserted, 
has  been  found  to  produce  poisonous  effects,  when  taken  on  an 
empty  stomach.  Occasionally,  the  emetic  acts  longer,  or  more 
severely,  than  is  desirable.  In  such  case,  a few  drops  of  laudanum, 
or  of  laudanum  and  ether  ; or  a teaspoonful  of  brandy ; or  a drop  of 
creasote,  may  be  prescribed.  A teaspoonful  of  magnesia  in  a glass 
of  sherry  wine  has  been  advised  with  the  same  object.  These  ex- 
citants are  not  often,  however,  needed.  Frequently  a mustard  plas- 
ter to  the  pit  of  the  stomach  is  adequate  to  the  emergency. 

If  the  object  of  the  practitioner  be  to  excite  a new  nervous  im- 
pression, the  greater  the  amount  of  retching,  within  due  limits,  the 
better.  At  times,  emetics  not  only  produce  emesis,  but  they  excite 
violent  catharsis  ; or  they  may  induce  the  latter  effect  without  the 
former.  In  such  cases,  a fevr  drops  of  laudanum  have  succeeded  in 
restricting  their  operation  to  the  stomach.  In  very  irritable  indi- 
viduals, too,  the  emesis  may  go  to  an  inordinate  extent,  so  as  to  ex- 
haust by  the  repeated  retching  and  vomiting.  Carbonic  acid,  — as 
contained  in  soda  water,  or  as  given  off  by  the  union  of  tartaric 
acid  and  carbonate  of  soda,  — or  opium,  or  some  rubefacient  to  the 
epigastric  region,  may  be  required  to  check  it. 

Reference  has  been  made  to  the  evils  resulting  from  the  repeated 
employment  of  emetics  as  regards  the  gastric  functions,  as  well  as  to 
the  mischief  they  may  induce  in  particular  states  of  the  system.  One 
other  inconvenience  resulting  from  them,  — or  rather,  said  to  result 
from  them,  but  of  which  the  author  has  not  seen  an  example,  — 
is  that  of  inflammation  of  the  extremities,  followed  by  gangrene.  M. 
Barbier  — an  eminent  French  wTiter  on  therapeutics  — has  cited 
the  following  case.  — A woman,  of  a constipated  habit,  had  used 
many  means  for  producing  catharsis,  but  ineffectually,  when  a sur- 
geon to  whom  she  applied  administered  a violent  preparation,  which 
operated  both  upwards  and  downwards.  Cramps,  convulsions  of 
the  limbs,  and  great  anguish  supervened.  Immediately  afterwards 
she  was  attacked  with  severe  lancinating  pains  of  the  extremities, 
and  ecchymoses  appeared  on  different  parts  of  the  body.  Gangrene 
attacked  the  cartilaginous  portion  of  the  nose,  the  lower  lip,  the  skin 
of  the  chin,  the  points  of  two  toes  of  the  right  foot,  and  the  great  toe 


IN  INTERMITTENT  FEVER. 


105 


of'  the  left,  all  of  which  successively  dropped  off.  To  this  case 
Barbier  adds  one  of  his  own.  A woman,  of  the  Faubourg  d’Amiens, 
having  procured  a cathartic  remedy  from  an  herbalist,  was  attacked, 
after  taking  it,  with  incessant  vomiting  and  purging,  which  rapidly 
reduced  her  strength.  She  was  taken  to  the  Hotel-Dieu.  Next  day 
the  point  of  the  nose,  the  ears,  and  the  cheeks  became  of  a deep 
violet  hue,  and  soon  afterwards  the  same  colour  spread  over  the  feet 
and  the  hands,  and  gangrene  rapidly  attacked  all  these  parts.  She 
lost  one  of  her  feet,  and  several  toes  of  the  other. 

These  cases  do  not  seem  to  prove  incontestably,  that  the  gangrene 
was  dependent  upon  the  use  of  emetics.  The  effects  may  have  been 
coincident,  instead  of  consequent ; and  if  any  such  evil  were  to  be 
apprehended  from  them,  we  ought  assuredly  to  possess  a greater  num- 
ber of  examples. 

Therapeutical  Application  of  Emetics. 

After  this  full  investigation  of  the  general  effects  consequent  on 
the  administration  of  emetics,  their  therapeutical  application  to  par- 
ticular diseases  will  be  intelligible. 

Intermittent  fevers. — In  intermittent  fevers,  they  are  employed 
with  two  objects, — either  to  excite  a powerful  nervous  impression, 
or  to  simply  evacuate  the  contents  of  the  stomach,  and,  according  as 
the  practitioner  has  one  or  other  of  these  objects  in  view,  he  selects 
his  particular  emetic  accordingly. 

For  exciting  a powerful  nervous  impression,  one  which  produces 
much  nausea  and  vomiting  is,  as  already  inculcated,  to  be  preferred ; 
whilst  if  simple  evacuation  be  desirable,  it  matters  not  how  trivial 
the  nausea  or  disorder  may  be.  Practitioners,  however,  generally 
have  recourse  to  the  nhrate  of  antimony  and  potassa,  and  ipecacu- 
anha, singly  or  combined.  The  latter  is  perhaps  the  more  certain 
agent ; and  it  has  the  advantage,  that  no  very  great  attention  is  re- 
quired to  the  dose, — sixty  grains  not  usually  producing  more  effect 
than  thirty. 

Where  the  object  is  to  arrest  the  paroxysm  of  an  intermittent,  the 
emetic  should  be  exhibited  a short  time  before  the  cold  stage  is  ex- 
pected ; and  should  it  even  not  have  the  effect  of  completely  pre- 
venting the  fit,  it  may  essentially  mitigate  it. 

The  first  impression,  made  by  an  emetic  of  antimony,  or  of 
ipecacuanha,  is  one  of  diminished  action  ; the  second  is  one  of  equalis- 
ation ; so  that  although  the  former  operation  might  appear  inappro- 
priate in  a case  of  diminished  action,  like  that  of  the  cold  stage  of 
an  intermittent,  the  latter  might  be  decidedly  advantageous  ; and  this 
latter,  it  would  seem,  predominates  over  the  former,  inasmuch  as  no 
evil  is  found  to  result  from  the  employment  of  emetics  in  the  cold 
stage.  Even  in  those  pernicious  intermittents, — ilie^fehres  algidce^ 
as  they  have  been  termed, — in  which  reaction,  if  established  at  all, 
is  so  with  difficulty,  they  have  been  found  decidedly  useful.  In 


106 


EMETICS 


such  cases,  emetics,  which  produce  the  equalisation  without  the  de- 
pression, are  obviously  indicated  — as  sulphate  of  zinc,  or  sulphate  of 
copper;  — but  those  of  the  indirect  kind  have  been  exhibited  with 
impunity,  and  even  with  advantage. 

In  the  hot  stage,  emetics  have  likewise  been  given,  but  they  seem 
to  make  less  impression  where  all  is  exaltation,  and  they  are  ob- 
viously not  as  much  indicated  as  when  the  action  is  to  a less  extent, — 
although  nauseants  may  be  most  useful. 

The  truth  is,  that,  during  the  paroxysm  of  an  intermittent,  it  is 
not  generally  necessary  to  do  much.  The  management  on  general 
principles  is  alone  necessary ; — hot  fluids  being  prescribed  in  the 
cold  stage  ; cold  in  the  hot ; and  tepid  in  the  sweating. 

In  the  state  ot  apyrexia,  emetics  prepare  the  way  for  the  adminis- 
tration of  tonics,  which  are  thus  enabled  to  come  into  more  immediate 
contact  with  the  lining  membrane  of  the  stomach,  and  to  exert  their 
appropriate  agency  on  it,  and  through  it,  on  the  rest  of  the  nervous 
system.  In  all  periods  of  the  affection,  a gentle  emetic,  given  merely 
to  remove  morbid  secretions,  may  be  advantageous,  but  their  repeated 
use  must  be  avoided. 

Remittent  fevers. — In  remittent  fevers,  which  are  commonly  ac- 
companied by  more  or  less  excitation  in  the  lining  membrane  of  the 
stomach  and  intestines — especially  of  the  upper  portions  — active 
emetics  are  not  advisable;  but  gentle  evacuants  may  be  administered 
not  only  without  detriment,  but  with  advantage.  Their  repeated 
use,  however,  in  such  cases,  is  apt  to  augment  the  irritation,  already 
existing  in  the  mucous  membrane  of  the  digestive  tube,  and  to  in- 
crease the  sensibility  of  that  of  the  stomach  in  particular. 

Fevers  in  general. — From  the  equalising  effect  of  emetics,  they 
may  be  used  at  the  commencement  of  almost  all  fevers  with  advan- 
tage ; and,  at  times,  they  would  appear  to  cut  short  the  complaint, 
although  probably  much  less  frequently  than  has  been  imagined. 

In  cases  of  ephemera^  which  most  frequently  occurs  in  children, 
but,  at  times,  in  adults  also,  and  is  dependent  upon  gastric  disorder 
produced  by  errors  in  diet,  emetics  are  obviously  indicated,  and,  by 
removing  the  cause  of  the  fever,  may  put  an  end  to  the  febrile  ac- 
tion ; but  it  is  not  easy  to  cut  short  a continued  fever,  after  it  has 
gone  on  for  some  days,  by  this  or  by  any  other  plan.  Such,  at  least, 
has  been  the  result  of  the  author’s  observation,  and  it  accords  with 
that  of  others,  whose  opportunities  have  been  extensive.  In  almost 
all  fevers,  termed  continued^  two  exacerbations  in  the  day  can  be 
perceived  ; — the  one  about  mid-day,  and  the  other  in  the  evening  ; 
and  it  has  been  conceived,  that  where  the  object  is  to  cut  short  the 
fever,  the  emetic,  as  in  the  case  of  an  intermittent,  should  be  given 
a short  time  before  the  expected  exacerbation,  and  especially  before 
that  in  the  evening,  which  is  usually  more  marked  than  the  other. 

The  modus  operandi  of  emetics,  in  cutting  short  a continued  fever. 


IN  PHLEGMASIiE. 


107 


is  the  same  as  in  the  case  of  intermittents  ; — that  is,  by  the  revul- 
sion they  produce  ; and  the  equalising  influence  exerted  by  them  on 
the  sanguiferous  and  nervous  systems.  Hence,  they  are  occasion- 
ally advantageous  in  the  major  exanthemata^  especially  when  the 
eruption  does  not  appear  freely  and  equably,  but  seems  to  be  re- 
strained or  repressed,  in  consequence  of  irritation  existing  in  some 
internal  organ.  Broussais,  with  the  dogmatism  that  is  too  apparent 
in  his  writings,  lays  down  a law  of  action,  which  admits  of  many 
exceptions.  — Emetics  cure  gastro-enteritis  solely  by  the  revulsion, 
and  the  critical  evacuations  which  they  provoke  ; their  effect  is  then 
uncertain  in  mild  cases  ; and,  in  severe  ones,  they  are  always  dan- 
gerous, because  they  never  fail  to  augment  the  inflammation,  when 
they  do  not  succeed  in  removing  it.”  — Prop.  287.  And,  again, 
‘‘  Emetics,  purgatives,  and  tonics,  which  act  by  revulsion,  affect 
only  temporary  cures  in  chronic  gastritis  and  gastro-enteritis,  and 
render  the  radical  cure  more  difficult.”  Prop.  349;  — ‘^propo- 
sitions,” which  must  be  regarded  as  mere  assertions  emanating  from 
a distinguished  mind,  but  not  on  that  account  to  be  received  as 
authority,  in  the  absence  of  evidence. 

It  need  scarcely  be  said,  that  in  the  course  of  continued  fever, 
morbid  secretions  must  take  place  from  the  lining  of  the  alimentary 
tube  as  in  remittents  and  intermittents,  but  as  these  can  generally  be 
evacuated  by  cathartics,  they  are  usually  employed  to  the  exclusion 
of  emetics. 

Inflammations.  — In  the  different  phlegmasiae,  emetics  are  much 
used.  In  some,  however,  they  are  more  effective  than  in  others. 
In  laryngo-tracheitis  or  croup,  they  are  given  in  very  different  stages 
of  the  disease,  to  fulfil  different  indications,  and  with  equal  pro- 
priety. At  the  commencement  of  an  attack,  both  of  spasmodic  and 
inflammatory  croup,  an  emetic,  by  exciting  a salutary  revulsion,  and 
equalising  the  circulation,  frequently  puts  an  end  to  the  affec- 
tion ; and  even  if  the  disease  has  made  some  progress,  it  is  a valuable 
agent,  after  blood-letting.  Accordingly,  it  is  one  of  the  remedies 
most  employed  in  the  early  stages  of  croup. 

It  is  equally  indicated  after  the  plastic  secretion  has  been 
thrown  out  from  the  membrane ; but  it  must  obviously  be  a matter 
of  extreme  difficulty,  by  any  agency,  to  cause  the  detachment  of  the 
false  membrane,  and  its  expulsion  through  the  narrow  chink  consti- 
tuting the  rima  glottidis,  when  it  has  formed  in  the  trachea  ; yet  the 
best  expectorant  agency  that  can  be  exerted,  is  effected  by  the  suc- 
cussion,  which  the  action  of  an  emetic  occasions. 

The  same  remarks  apply  equally  to  the  inflammation  of  the  lining 
membrane  of  the  larynx,  that  constitutes  laryngitis. 

In  or  inflammation  of  the  tonsils,  as  well  as  in  pharyn- 

gitis and  (esophagitis^  the  same  good  effects  are  produced  by  the 
revellent  and  equalising  agency  of  emetics  ; and  when  suppuration 
has  supervened,  and  the  abscess  is  seated  so  low  down  in  the  pharynx 


108 


EMETICS 


or  oesophagus,  that  it  cannot  be  reached  by  the  instrument  of  the 
surgeon,  the  operation  of  an  emetic  may  cause  it  to  break.  With 
this  view,  one  of  the  direct  emetics  may  be  prescribed.  No  great 
impression  on  the  nervous  system  is  needed.  The  expulsive  efforts 
are  alone  required  ; and  the  sulphate  of  zinc,  or  the  sulphate  of 
copper,  is  capable  of  fulfilling  every  indication.  In  the  malignant 
varieties  of  cynanche^  which  so  often  accompany  scarlatina,  emetics 
are  frequently  administered.  Much  curative  influence  cannot,  how- 
ever, be  expected  from  them,  except  at  the  very  commencement  of 
these  affections  ; but  at  a subsequent  period,  they  may  be  given  with 
the  view  of  removing  the  viscid  secretions,  which  excite  so  much 
annoyance. 

Diseases  of  the  chest.  — Emetics  are  much  employed  in  different 
diseases  of  the  chest.  In  pneumonia^  they  are  not  often  used  before 
the  activity  of  vessels  has  been  diminished  by  the  proper  antiphlo- 
gistic remedies;  but  when  the  inflammation  has  been  somewhat 
subdued,  their  equalising  and  revulsive  influence  becomes  strikingly 
apparent.  They  favour  the  discharge  of  the  bronchial  secretions,  by 
the  succussion  they  communicate  to  the  lungs  ; and,  for  this  reason, 
they  are  employed  with  considerable  benefit  in  chronic  bronchitis. 

They  are,  likewise,  extremely  beneficial  in  nervous  cough,  hooping- 
cough,  and  asthma.  These  diseases  appear  to  be  dependent  upon  a 
morbid  condition  of  the  nerves  of  the  respiratory  organs — thepneumo- 
gastric  especially  — which  modifies  the  contractility  of  the  muscular’ 
fibres,  that  surround  the  minute  bronchial  ramifications  ; and  this 
state  of  the  nerves  is  generally  perhaps  connected  with  more  or  less 
derangement  of  the  parts  of  the  cerebro-spinal  axis,  whence  they 
originate.  Hence,  the  utility  of  producing  a revulsive  effect  by 
means  of  these  or  other  agents.  Expectoration  is  also  favoured  by 
them  in  the  manner  just  mentioned,  and  it  has  been  long  remarked, 
that  those  children  suffer  least  from  hooping-cough,  who  eject  the 
contents  of  the  stomach  during  each  fit  of  coughing. 

Diseases  of  the  encephalon.  — It  is  in  head  affections  that  the  use  of 
emetics  might  seem  most  doubtful.  In  encephalitis,  they  are  gene- 
rally esteemed  inadmissible ; and,  as  the  pain  in  the  head  is  almost 
intolerable,  their  operation  can  hardly  fail  to  aggravate  the  symptoms, 
notwithstanding  their  revellent  and  equalising  tendency.  The  same 
remarks  are  applicable  to  their  employment  in  apoplexy.  The  violent 
efforts,  forcing  the  blood  with  greater  impetus  to  the  head  by  the 
arteries,  and  retarding  its  return  by  the  veins,  appear  inappropri- 
ate in  cases  in  which  hypersemia  already  exists  in  the  encephalon, 
yet  their  revellent  properties  would  seem  to  have  rendered  them 
useful  in  ophthalmia,  when  blood-letting,  counter-irritants,  &c.,  had 
been  prescribed,  and  the  disease  had,  notwithstanding,  remained 
stationary.  In  these  very  cases,  the  same  substances,  employed  so 
that  their  operation  may  be  confined  to  exciting  nausea,  are  amongst 


IN  BUBO  AND  ORCHITIS. 


109 


Our  most  valuable  remedies,  and  not  in  these  affections  only  but  in 
every  variety  of  phlegmasia. 

jimaiirosis.  — Amaurosis  is  said  to  have  been  beneficially  treated 
by  emetics,  but  much  reliance  obviously  cannot  be  reposed  on  them, 
when  the  retina,  or  the  optic  nerve,  or  the  part  of  the  brain  in  which 
the  optic  nerve  arises,  is  affected  with  paralysis.  Impaired  or  de-, 
praved  vision  often  occurs  sympathetically  from  disorder  of  the  diges- 
tive functions ; at  other  times,  it  is  owing  to  lesion  of  the  eye  itself, 
or  of  the  cerebral  part  of  the  organ  of  vision  ; hence  the  affection 
termed  myodesopsia  or  musece  volitantes  is  symptomatic  of  one  or 
other  of  these  morbid  conditions ; and  hence  the  various  hallucina- 
tions, illusions  or  waking  dreams,  which  occur  in  diseases  of  the 
encephalon,  as  mania  and  hypochondriasis,  but  which  are  often  pro- 
duced in  persons  of  sound  mind,  whose  nervous  systems  are  unu- 
sually impressible,  and  easily  acted  upon  by  irritations  in  the  stomach, 
or  elsewhere. 

Where  the  primary  mischief  in  such  affections  is  in  the  stomach 
or  intestines,  emetics  are  more  likely  to  afford  relief  than  when  the 
depravation  is  seated  originally  in  the  encephalon. 

Bubo  and  orchitis.  — In  certain  local  affections  — as  bubo  and 
orchitis  — the  revellent  action  of  an  emetic  is  often  most  beneficial. 
The  inflammation  may  have  been  vigorously  attacked  by  the  proper 
antiphlogistic  measures,  yet  the  swelling  may  remain  stationary.  If 
a powerfully  revellent  nervous  impression  be  now  made,  by  exciting 
emesis,  the  swelling  will  frequently  disappear. 

In  the  very  early  stages  of  orchitis,  or  bubo,  the  revulsion,  thus 
produced,  is  by  no  means  as  efficacious.  The  excited  state  of  ves- 
sels generally  predominates  too  much  to  be  broken  in  upon  by  any 
impression  upon  the  nervous  system.  The  state  of  vessels  must  be 
reduced  by  antiphlogistics,  and  then  emetics  may  be  had  recourse  to 
with  full  advantage. 

Phthisis  pulmonalis.  — In  phthisis  pulmonalis,  emetics  were  at  one 
time  considered  the  best  remedies  : and,  according  to  one  writer. 
Dr.  Young,  a majority  of  the  cures  of  phthisis  have  been  effected  by 
them  or  by  nauseating  agents.  This  idea  probably  originated  from 
the  good  effects  observed  to  follow  a sea  voyage,  which  is  usually 
accompanied  by  sea-sickness;  but  the  fallacy,  in  this  case,  consists, 
in  referring  that  to  the  nausea,  which  may  be  produced  by  the  greater 
equability  of  temperature  at  sea,  and  by  the  new  impressions  made 
upon  the  mind  and  nervous  system  of  the  voyager,  through  the 
altered  barometrical,  hygrometrical,  thermometrical,  electrical  and 
other  conditions  of  the  atmosphere,  and  by  the  new  scenes  in  which 
the  patient  is  placed.  Even  in  the  early  stages  of  phthisis,  when 
alone  any  course  of  medication  can  be  expected  to  be  effective, 
emetics  are,  at  the  present  day,  but  rarely  had  recourse  to.  In  the 
later  periods  of  the  disease,  they  are  not  only  useless,  but  add  to  the 
existing  irritation  and  debility. 

Diseases  of  the  alimentary  canal.  — In  gastritis,  and  enteritis,  eme- 
VOL.  II.  — 10 


110 


EMETICS. 


tics  are  manifestly  not  needed,  and  would  probably  be  injurious  ; 
nor  would  they  appear  to  be  indicated  in  spontaneous  vomiting ; but, 
as  diarrhoea  is  often  kept  up  by  irritations  in  the  intestinal  canal,  and 
requires  the  administration  of  a cathartic  to  remove  them,  so  vomit- 
ing may  suggest  the  use  of  an  emetic  ; and  even  when  the  spontane- 
ous vomiting  has  persisted  after  the  contents  of  the  stomach  have 
been  evacuated,  the  new  action,  induced  by  an  emetic,  may  break 
in  upon  the  disorder  of  function,  and  remedy  the  evil. 

In  dyspepsia^  emetics  are  occasionally  prescribed,  but  they  must  be 
employed  with  caution.  A gentle  emetic  removes  indigestible 
matters  and  morbid  secretions,  and  produces  an  excitation  in  the 
stomach  which  may  be  salutary ; but  repeated  emetics,  as  has  been 
previously  shown,  injure  the  tone  of  the  organ,  develope  its  sensi- 
bility, and  augment  the  very  affection  for  the  removal  of  which  they 
were  administered. 

In  cholera  — both  of  the  indigenous,  and  foreign  variety — gentle 
emetics  are  prescribed  by  some  practitioners,  and  as  means  for  the 
removal  of  morbid  secretions  they  may  be  useful ; but  it  is  not  clear, 
that  they  ought  to  be  regarded  as  of  much  efficacy  in  affections  that 
are  dependent  upon  an  irritated  or  excited  state  of  the  gastro-intes- 
tinal  mucous  membrane,  and  which  yield  with  the  subsidence  of  the 
inflammatory  irritation, — or  terminate  unfavourably,  when  the  morbid 
affection  of  the  membrane  in  general,  and  of  the  exhalants  in  particu- 
lar, is  excessive. 

In  cases  of  malignant  c/m/em,  the  stimulating  emetics  — as  mus- 
tard — have  been  most  frequently  employed,  — the  inflammatory  irri- 
tation of  the  mucous  membrane  in  these  malignant  cases  being 
occasionally  diminished  by  gentle  excitants,  as  we  have  seen  it  may 
be  in  affections  of  the  mucous  membranes  in  general,  when  the  over- 
distended state  of  extreme  vessels  is  the  prominent  pathological 
lesion.  A main  part  of  the  benefit,  however,  accruing  in  such  cases, 
is  probably  derived  from  their  revulsive  operation,  — the  chief  patho- 
logical mischief  being  usually  situate  lower  down  in  the  tube.  It 
has,  indeed,  been  a question,  with  some  therapeutists,  whether  ad- 
vantage might  not  be  derived,  in  these  unfortunate  cases,  from  reme- 
dies that  might  even  inflame  the  lining  membrane  of  the  stomach  ; 
but  such  a harsh  plan  of  revellent  treatment  could,  of  course,  be 
scarcely  admissible. 

In  diarrhoea  and  dysentery^  where  the  irritation  is  seated  lower 
down  in  the  tube,  an  emetic  may  produce  good  effects  as  a revulsive  ; 
but,  in  the  latter  disease,  the  violence  of  the  inflammation  must  be 
previously  subdued  by  appropriate  agents.  It  would  seem,  too,  that 
in  certain  cases  of  constipation,  accompanied  with  spasmodic  con- 
striction of  the  muscular  coat  of  the  intestines,  emetics,  administered 
after  blood-letting,  have  relaxed  the  spasm,  so  that  the  bowels  have 
been  relieved,  or  gentle  cathartics  have  afterwards  been  sufficient. 

In  dysentery  the  seat  of  which  is  chiefly  in  the  lining  membrane 
oif  the  large  intestine,  the  revellent  and  equalising  effects  of  emetics 
ar«e  beneficially  manifested. 


IxN  HEMORRHAGES. 


Ill 


Rheumatism  and  gout. — In  acute  rheumatism  and  gout,  emetics 
are  not  much  used,  although  occasionally  their  operation  — as  revel- 
lents  and  equalisers  — may  be  advantageously  exerted.  In  the  latter 
disease,  connected  as  it  is  with  considerable  gastric  disorder,  their 
use  might  seem  to  be  more  especially  indicated  ; and  in  both  diseases 
they  may  be  demanded  for  the  removal  of  morbid  secretions,  or  of 
undigested  matters  from  the  tube, — a result,  which  can  generally, 
however,  be  accomplished  by  the  use  of  gentle  cathartics. 

Hemorrhages. — After  what  has  been  said  of  the  general  mode  of 
action  of  emetics,  and  of  their  application  to  the  ordinary  phlegmasise, 
their  agency  in  hemorrhages  will  be  apparent.  In  epistaxis,  they 
cannot  be  required,  and  their  employment  in  apoplexy ^ — it  has  been 
already  seen, — is  a more  than  questionable  measure.  The  same,  it 
has  been  thought,  may  be  said  of  hcemoptysis.  Although  their  equa- 
lising and  revulsive  operation  might  act  advantageously,  it  has  been 
conceived,  that  the  activity  they  occasion  in  the  vascular  movements, 
might  more  than  compensate  for  their  salutary  agency.  Yet,  it  has 
not  been  found,  that  haemoptysis,  symptomatic  of  phthisis,  has  re- 
curred, or  been  increased  at  sea  during  the  retching  of  sea-sickness. 
In  such  cases,  nauseating  doses  are  recommended,  which,  as  before 
shown,  produce  an  effect  of  a directly  opposite  character,  so  as  to 
give  occasion  to  their  being  classed  amongst  agents  that  diminish 
action. 

In  hcematemesis , emetics  have  been  recommended  by  some,  with 
the  view  of  removing  the  accumulations  of  blood,  which  form  in  the 
stomach;  and,  in  this  respect,  they  may  be  of  service.  The  hemor- 
rhage, in  these  cases,  is  generally  venous,  and  takes  place  by  dia- 
pedesis  or  transudation,  — often  owing  to  visceral  engorgement, 
which  prevents  the  blood  from  circulating  freely  in  the  engorged 
organ,  and  occasions  irregular  congestions  in  other  parts.  In  such 
cases,  emetics  ought  to  be  administered  with  caution.  In  the  wards 
of  the  Philadelphia  Almshouse,  we  annually  meet  with  cases  of  heema- 
temesis,  meleena,  and  epistaxis,  occasioned  by  engorgement  and  in- 
duration of  the  liver  or  spleen,  especially  the  latter,  acquired  in 
malarious  districts.  The  proper  treatment  of  the  hemorrhage  neces- 
sarily merges  in  that  of  the  primary  affection  on  which  it  is  de- 
pendent. 

In  cases  of  simple  haematemesis,  the  action  of  the  stomach,  induced 
by  an  emetic,  may  occasion  the  removal  of  the  venous  congestion, 
and  the  pressure  of  the  muscular  coat  of  the  viscus  on  the  vessels 
exhaling  the  blood  may  tend  to  contract  their  dimensions,  and  to 
arrest  the  How,  somewhat,  perhaps,  in  the  manner  that  the  hemor- 
rhage is  arrested  in  the  next  variety  to  be  considered. 

Uterine  hemorrhage  may  occur  prior  to,  during,  and  subsequent  to, 
the  delivery  of  the  child.  In  all  cases,  it  is  produced  by  a discharge 
from  the  uterine  vessels.  The  old  idea,  universally  entertained, 
was, — that  the  vessels  of  the  mother  pass  directly  to  the  placenta, 
and  pour  their  blood,  by  open  mouths,  into  the  maternal  portion  of 


112 


EMETICS 


that  organ.  Under  this  view  of  the  subject,  hemorrhage  would  be 
})roduced  by  a rupture  of  the  maternal  vessels.  Some  observers 
have  satisfied  themselves,  that  there  is  no  direct  communication  be- 
tween the  uterine  vessels  and  the  placenta,  but  that  these  vessels 
coast  along  the  uterine  parietes  in  a direction  parallel  to  the  placenta, — 
having,  however,  portions  scooped  out  of  their  sides,  which  portions 
are  closed,  either  directly  or  indirectly,  by  the  placenta.  Under  this 
view,  there  can  of  course  be  no  maternal  and  foetal  portions  of  the 
placenta;  the  whole  is  foetal,  and  hemorrhage  arises  from  the  de- 
tachment of  the  decidua  or  of  the  placenta  from  the  apertures  in  the 
uterine  vessels.  Whatever,  therefore,  induces  contraction  of  the 
uterus,  occasions  the  reapplication  of  the  placenta,  or  of  the  body  of 
the  child  to  the  vessels  whence  the  hemorrhage  proceeds,  and  arrests 
it.  These  remarks  apply,  of  course,  only  to  hemorrhage  occurring 
jirior  to,  or  during  delivery,  and  then  only  to  cases  in  which  the 
placenta  is  situate  elsewhere  than  over  the  os  uteri. 

In  uterine  hemorrhage  following  the  delivery  of  the  ovum,  the 
hemorrhage  is  arrested  by  causing  the  uterus  to  contract  upon  itself, 
and  thus  to  obliterate,  as  it  were,  the  maternal  vessels  ; and  emetics, 
which  call  into  action  the  abdominal  muscles,  facilitate  this  result, 
although  they  are  but  rarely  had  recourse  to,  seeing,  that  the  ob- 
stetrical practitioner  has  more  effectual  means  for  attaining  his 
object. 

Jaundice.  — In  jaundice,  dependent  — as  it  often  is — on  some 
impediment  to  the  flow  of  bile  along  the  biliary  ducts  into  the  duo- 
dedum,  and  especially  when  produced  by  a gallstone,  the  inverted 
action  and  the  succussion,  induced  by  the  operation  of  an  emetic, 
are  often  beneficial,  and  the  same  remark  holds  good  in  cases  of 
cholelithus  or  gallstone  without  jaundice.  Here,  an  emetic  should 
be  selected,  whose  operation  is  preceded  by  nausea  — as  tartar 
emetic  or  ipecacuanha — the  relaxing  influence  of  which  is  first  felt, 
and  this  is  immediately  succeeded  by  the  propulsory  efforts,  which 
are,  at  times,  successful  in  causing  the  calculus  to  clear  the  biliary 
passages.  It  has  been  properly  remarked,  however,  that  emetics 
are  more  advantageous  and  safe  in  the  early  than  in  the  later  periods 
of  jaundice,  when  there  is  reason  to  believe  in  the  existence  of 
organic  disease  of  the  liver  ; and  also,  that  they  should  be  used  with 
caution,  when  there  is  evidence  of  distention  of  the  gall-bladder, — 
indicated  by  a tumour  felt  on  pressing  the  right  hypochondrium. 
Under  such  circumstances,  the  operation  of  an  emetic  has  been 
known  to  occasion  rupture  of  the  gall-bladder  and  fatal  peritonitis. 

JVeuroses.  — In  mental  alienation.,  emetics  were  at  one  time  much 
advised,  and  some  of  the  most  noted  remedies  possessed  properties 
of  this  kind.  They  are  not  given  at  the  present  day,  unless  symp- 
toms should  arise  in  the  course  of  the  disease  to  indicate  their  ad- 
ministration. In  the  cases  in  which  they  are  presumed  to  have 
everted  a salutary  agency,  this  was  probably  accomplished  less  by 


Ix\  DllOPSY. 


113 


their  acting  as  evacuants,  or  through  modifications  induced  in  the 
circulation,  than  by  the  new  impression  made  by  them  upon  the 
nervous  system.  Hence,  they  are  occasionally  used  in  mania  to 
interrupt  intense  abstractions.  When  the  insane  obstinately  deter- 
mines to  retain  his  urine  and  faeces,  an  emetic  often  succeeds  in 
breaking  in  upon  the  determination  ; and  the  same  applies  to  those 
who  are  affected  with  delirium  tremens^  in  which  disease  emetics 
have  been  wholly  relied  on  by  some.  (For  the  author’s  views  on 
this  subject  see  his  Practice  of  Medicine^  2d.  edit,  ii.,  274,  Phila- 
delphia, 1844.)  In  all  such  cases,  emetics  have  to  be  given  in 
larger  doses  than  usual.  The  encephalon  being  in  a state  of  excite- 
ment, and  employed  in  its  own  acts,  is  less  affected  by  impressions 
made  on  other  organs,  and,  consequently,  requires  a larger  amount 
of  the  impressing  agent ; but  if  the  energy  of  the  system  be  first  re- 
duced by  a copious  abstraction  of  blood,  then  the  ordinary  dose  of 
the  emetic  may  produce  its  accustomed  effects. 

In  hypochondriasis^  which  is  an  encephalic  disorder,  accompanied 
generally  with  much  gastric  derangement,  an  occasional  emetic 
often  acts  beneficially,  by  exciting  a new  action  in  the  nervous 
system,  and  giving  an  impulse  to  functions  carried  on  with  unusual 
torpor. 

In  epilepsy^  and  in  the  convulsions  of  children^  emetics  are  not 
only  excellent  prophylactics,  but  valuable  curative  agents.  Where 
organic  mischief  does  not  exist,  these  diseases  are  usually  induced 
by  great  mobility,  or  impressibility  of  the  encephalon,  developed 
by  irritation  in  some  other  part  of  the  system,  and  especially  in  the 
digestive  tube.  Often,  this  is  produced  by  indigestible  diet,  or  by 
morbid  secretions,  and  when  the  prodromic  or  premonitory  symp- 
toms of  the  attack  are  present,  a timely  emetic  may  prevent  the 
paroxysmj  by  removing  the  cause,  and  exciting  a new  nervous  im- 
pression, as  in  the  case  of  ifitermittents. 

The  same  kind  of  revulsion  is,  at  times,  salutary  in  hysteria^  as 
well  as  in  the  different  forms  of  neuralgia.  The  impression  of 
the  emetic  is  powerfully  exerted  on  the  stomach,  and  thence  irradi- 
ates to  every  part  of  the  nerv^ous  system,  and,  by  equalising  the 
nervous  distribution  or  influx,  detracts  from  its  intensity  in  any 
given  point. 

Dropsy.  — Lastly,  emetics  have  been  frequently  exhibited  in  the 
different  varieties  of  dropsy,  and  they  are  calculated  to  act  as  pro- 
moters of  absorption  in  such  cases  ; — not  so  much  in  consequence 
of  any  increased  action  of  the  exhalants  of  the  lining  membrane  of 
the  stomach,  which  they  may  occasion,  as  by  their  revulsive  opera- 
tion. Dropsies,  as  will  be  seen,  have  been  known  to  disappear 
under  powerful  mental  emotions,  and  not  only  dropsies,  but  deposi- 
tions of  solid  materials,  and  we  can,  therefore,  understand,  that  these 
affections  may  diminish  under  the  nervous  derivation  excited  by  an 
emetic.  They  cannot,  however,  be  repeated  sufficiently  often  to 
10*^ 


114 


SPECIAL  EMETICS. 


produce  much  salutary  influence,  for  fear  of  injuring  the  tone  of  the 
stomach  ; and  accordingly  they  are  but  rarely  employed  in  the  treat- 
ment of  hydropical  affections. 

Such  are  the  diseased  conditions  in  which  emetics  are  especially 
serviceable.  It  is  obviously  impossible  to  specify  every  variety  of 
organic  lesion  in  which  they  may  be  salutary.  Enough  has  been  said 
of  their  general  properties,  and  particular  applications,  to  suggest 
the  cases  in  which  their  administration  may  be  indicated. 


SPECIAL  EMETICS. 
a.  Direct  Emetics. 

I.  ZINCI  SULPHAS.— SULPHATE  OF  ZINC. 

Sulphate  of  zinc  occurs  in  commerce  in  an  impure  state,  under 
the  name  of  White  Vitriol^  by  which,  indeed,  it  was  long  known  in 
medicine.  The  salt,  however,  always  contains  iron,  and  commonly 
copper  and  lead  ; and  therefore,  for  pharmaceutical  purposes,  it  is 
directed  to  be  prepared  by  the  union  of  oxide  of  zinc  and  sulphuric 
acid. 

Sulphate  of  zinc  is  in  colourless  crystals,  which  effloresce  on  ex- 
posure to  the  air.  It  is  wholly  dissolved  by  water,  by  2^^^^  of  its 
weight  of  cold  water,  and  by  less  than  its  own  weight  of  boiling  water. 
It  is  insoluble  in  alcohol.  The  solution  in  water  affords  with  am- 
monia a white  precipitate,  which  is  redissolved  by  the  alkali  in  ex- 
cess. It  also  yields  white  precipitates  with  chloride  of  barium,  fer- 
rocyanuret  of  potassium,  and  sulphohydrate  of  ammonia. 

Sulphate  of  zinc,  which  is  tonic  in  small  doses,  is  a rapid  and 
safe  emetic  ; and  hence  is  given,  when  it  is  desirable  to  evacuate  the 
contents  of  the  stomach  speedily,  as  when  poison  has  been  taken. 
The  dose  for  this  purpose  is  from  ten  to  thirty  grains.  In  excessive 
doses  it  acts  as  an  irritant  poison. 

2.  CUPRI  SULPHAS.  — SULPHATE  OF  COPPER. 

Sulphate  of  Copper,  Roman  or  Blue  Vitriol^  or  Blue-stone^  used 
in  the  United  States,  is  formed  by  a direct  combination  between  old 
scrap  copper  and  sulphuric  acid.  This  is  always  made  on  the  large 
scale  ; and  hence  it  is  not  in  the  Ikt  of  preparations  of  the  Pharma- 
copoeia of  the  United  States,  but  in  that  of  the  materia  medica.  It 
occurs  in  rich  blue  crystals,  which  are  wholly  soluble  in  water,  and 
Jightly  efflorescent  in  the  air.  It  is  insoluble  in  alcohol.  Ammonia 
throws  down,  from  a solution  of  the  salt  in  water,  a precipitate, 
which  is  entirely  redissolved  when  the  ammonia  is  added  in  excess. 


ANTIMONII  ET  POTASSiE  TARTRAS.  H5 

It  dissolves  in  about  four  parts  of  water  at  60°,  and  two  parts  of  boil- 
ing water. 

Like  sulphate  of  zinc,  sulphate  of  copper  is,  in  very  small  doses, 
a tonic ; and  in  larger  an  emetic.  It  is,  however,  much  more 
active,  and  in  considerable  doses  is  a highly  acrid  and  corrosive 
poison. 

Its  dose,  as  an  emetic,  is  from  two  to  five  grains,  given  in  water ; 
but  it  is  less  safe  than  the  sulphate  of  zinc. 

h.  Indirect  Emetics. 

1.  ANTIMO'NII  ET  POTAS'S.E  TARTRAS.— TARTRATE  OF  ANT'IMONY 
AND  POTAS'SA. 

Tartrate  of  Antimony  and  Potassa,  TarHarised  ant'imony^  Emet'ic 
Tartar j Tartar  Emet'ic  — in  the  Southern  states  of  the  Union  erro- 
neously termed  Tartar  — is,  perhaps,  more  frequently  used  as  an 
emetic  than  any  other  agent. 

In  the  Pharmacopoeia  of  the  United  States  (1842)  it  is  directed  to 
be  formed  as  follows: — Take  of  Sulphuret  of  Jintimonyfvo.  fine 
powder,  ^iv.  ; Muriatic  Acid^  .fxxv. : JYitric  Acid,  3ij« ; Water,  a 
gallon.  To  the  acids  mixed  in  a glass  vessel,  add  gradually  the 
sulphuret  of  antimony,  and  digest  the  mixture  with  a gradually  in- 
creasing heat  till  effervescence  ceases  ; then  boil  for  an  hour.  Filter 
the  liquor  when  it  has  become  cool,  and  pour  it  into  the  water. 
Wash  the  precipitated  powder  frequently  with  water,  till  it  is  wholly 
freed  from  acid,  and  then  dry  it*.  Take  of  this  powder,  5ij. ; Bitar- 
trate of  Potassa,  in  very  fine  powder,  giiss. ; Distilled  water,  f.  5xviij. 
Boil  the  water  in  a glass  vessel  ; add  the  powders  previously  mixed 
together,  and  boil  for  an  hour  ; filter  the  liquor  whilst  hot,  and  set  it 
aside  to  crystallise.  By  further  evaporation,  the  liquor  may  be  made 
to  yield  an  additional  quantity  of  crystals,  which  should  be  purified 
by  a second  crystallisation. 

Tartrate  of  antimony  and  potassa  consists  of  tartrate  of  antimony 
and  tartrate  of  potassa  ; and  the  object  of  the  above  process  is  first 
to  form  sesquioxide  of  antimony,  and  then  to  saturate  the  excess  of 
acid  in  the  bitartrate  of  potassa  with  it.  It  is  in  transparent  crystals, 
which  become  opaque  and  white  on  exposure  to  the  air.  As  met 
with  in  the  shops,  it  is  generally  in  powder,  and,  when  pure,  is  per- 
fectly white.  Dr.  Pereira,  however,  remarks,  that  some  ignorant 
druggists  prefer  a yellowish-white  powder  : and  he  was  informed  by 
a manufacturer  of  the  salt,  that  he  was  obliged  to  keep  two  varie- 
ties, — one  white,  the  other  yellowish- white, — to  meet  the  demands 
of  his  customers.  The  yellow  hue  is  owing  to  the  presence  of  iron. 

It  is  often  adulterated  with  bitartrate  of  potassa  ; and  it  has  been 
found  that  it  may  contain  10  per  cent,  of  it,  and  yet  dissolve  in  the 
proper  quantity  of  water.  It  is  wholly  soluble  in  14  or  15  parts  of 
water,  according  to  Dr.  Pereira  ; — according  to  the  Pharmacopoeia 
of  the  United  States,  in  20,  at  60°  Fahr.  Uncombined  bitartrate  of 


116 


SPECIAL  EMETICS. 


potassa  is  detected  by  adding  a few  drops  of  a solution  of  carbonate 
of  soda  to  a boiling  solution  of  the  antimonial  salt.  This  causes  a 
precipitate,  which  is  immediately  redissolved,  if  bitartrate  of  potassa 
be  present. 

When  tartrate  of  antimony  and  potassa  is  taken  in  very  large  doses, 
it  acts  as  a powerful  irritant  poison,  causing  direct  inflammation  of 
the  stomach  and  intestines.  It  is  likewise  an  irritant  when  applied 
to  the  cutaneous  surface.  Its  nauseant  and  emetic  properties  alone 
fall  under  consideration  in  this  place. 

As  a nauseant,  it  is  constantly  given  in  febrile  and  inflammatory 
affections,  in  such  doses  as  to  keep  up  the  action  of  sedation  suffi- 
ciently long  to  break  in  upon  the  chain  of  morbid  associations.  For 
this  purpose,  it  is  prescribed  in  the  dose  of  from  to  J a grain  every 
two  or  three  hours  ; carefully  regulating  the  quantity  and  the  periods 
so  as  to  prevent  the  supervention  of  vomiting. 

As  an  emetic,  it  may  be  given  alone,  or  in  union  with  ipecacuanha 
— one  or  two  grains  of  the  tartrate  to  fifteen  or  twenty  grains  of  the 
latter.  When  administered  alone,  it  should  be  in  divided  doses  ; — 
six  grains,  for  example,  being  dissolved  in  four  ounces  of  water,  and 
a fourth  part  given  every  fifteen  minutes  until  it  operates  ; — the 
action,  in  this  case,  as  in  that  of  every  other  emetic,  where  it  is  de- 
sirable to  evacuate  the  contents  of  the  stomach  freely,  and  there  is  no 
danger  of  dissolving  any  noxious  matter  that  may  be  contained  in  it, 
being  aided  by  drinking  freely  of  warm  water,  or  of  warm  chamo- 
mile tea.  For  reasons  already  assigned,  it  is  rarely  prescribed,  how- 
ever, where  any  poisonous  agent  has  been  taken,  — recourse  being 
then  had  to  direct  emetics. 

Being  devoid  of  taste,  it  is  a very  contenient  emetic  in  the  dis- 
eases of  infancy,  in  which  it  is  advisable  to  give  it  in  divided  doses 
until  vomiting  is  induced  ; and  it  is  doubtless  the  main  agent  in  some 
of  the  nauseating  and  emetic  preparations  so  commonly  used  in  such 
cases  in  domestic  practice. 

JIM  ANTIMO'Nn,  ANTIMONIAL  mm. —{Antim,  et  Potass.  Tartrat.dy. 
Vini^  f.  5X.)  Each  ounce  of  the  wine  contains  two  grains  of  the 
tartrate.  Antimonial  wine  is  commonly  kept  in  families,  and  it  has 
the  advantage,  which  a watery  solution  has  not,  of  keeping  well.  It 
is  readily  taken  by  children  as  wine.  It  is  not  well  adapted,  how- 
ever, as  an  emetic,  for  the  adult.  If  we  regard  the  ordinary  dose  of 
the  tartrate  of  antimony  and  potassa  to  be  two  grains,  it  would  re- 
quire one  ounce  of  the  wine,  which  might  be  injurious,  and  in  no 
circumstances  could  offer  advantages  over  the  aqueous  solution.  Ac- 
cordingly, it  is  rarely  prescribed  to  adults.  To  children,  under  five 
years  of  age,  the  vinum  antimonii  is  generally  given  in  the  dose  of  a 
tea-spoonful,  repeated  every  fifteen  or  twenty  minutes  until  it  acts. 

2.  IPECACUAN'HA. 

Ipecacuanha  is  the  root  of  Cephailis  Ipecacuan'ha ; Sex.  Svst. 


IPECACUANHA. 


117 


Pentandria  Monogynia ; Nat.  Ord.  Ru- 
biaceee,  — CinchonaceeB  (Lindley);  a small 
shrubby  plant,  which  grows  in  Brazil,  in 
moist,  shady  situations,  between  the  8th 
and  20th  parallels'  of  south  latitude.  It  is 
said,  also,  to  occur  in  New  Granada,  and 
in  some  of  the  West  India  islands.  The 
roots  are  gathered  at  all  seasons  of  the 
year,  but  especially  from  January  to  March 
inclusive. 

The  amount  on  which  duty  was  paid  in 
England,  in  1841,  was  9,623  lbs. ; but  a 
singular  fluctuation  as  to  quantity  is  pre- 
sented by  the  table  of  imports  for  the  last 
few  years,  which  is  as  follows  : (Pereira). 


Fig.  i. 


In  1834,  9,038  lbs. 

1835,  7,469 

1836,  11,437 

1837,  11,435 


In  1838,  12,426  lbs. 

1839,  7,453 

1840,  6,483 

1841,  9,623 


As  imported,  ipecacuanha  root  consists  of 
the  proper  knotty  root ; the  thinner,  woody  2. 

cylindrical  portion  by  which  it  is  attached  to 
the  stem,  and  frequently  a part  of  the  trailing 
portion  of  the  stem  also.  The  annulated  or 
ringed  portion — Radix  Ipecacuannice  annulaHce 
fusc(B,  of  continental  writers  — is  the  most 
active  part,  and,  therefore,  ought  alone  to  be 
used  by  the  apothecary. 

The  root  — as  we  meet  with  it  — is  of  about 
the  thickness  of  a small  goosequill,  and  of  a 
length  varying  from  two  inches  to  seven  ; 
contorted,  and  presenting  numerous  annular 
grooves,  which  give  it  a characteristic,  knotted 
or  ringed  appearance.  The  colour  varies, 
from  brownish,  reddish-brown,  grayish-brown 
to  gray.  Its  substance  consists  of  two  parts 
— the  one  constituted  of  the  bark,  the  other 
of  the  meditullium,  — the  proportion,  in  100 
parts  of  good  ipecacuanha,  being  80  of  the 
former  to  20  of  the  latter.  The  meditullium 
is  nearly  inert,  and  as  it  is  pulverisable  with 
more  difficulty  than  the  cortical  portion,  when 
the  pulverisation  is  effected  in  a mortar,  it 
may  happen,  that  the  portion  which  may  re- 
main last  in  the  mortar,  possesses  scarcely  any 
medicinal  property.  Generally,  however,  at 
the  present  day,  it  is  reduced  to  powder,  on 
a large  scale,  by  grinding,  so  that  this  separation  is  not  observable. 


Brown  Ipecacuanha  root. 
a.  Rintred  portion.  — b.  Por- 
tion without  rings.  (Pereira.) 


118 


SPECIAL  EMETICS. 


'Fhe  powder  of  ipecacuanha  has  a nauseous  odour,  and  on  some 
persons  produces  a peculiar  effect,  giving  rise  to  sneezing,  cough, 
dyspnoea,  and  all  the  symptoms  of  catarrhus  cestivus  or  hay  asthma, 
as  it  has  been  termed.  These  symptoms  pass  ofT  after  a time,  and 
generally  with  a copious  secretion  from  the  bronchial  tubes.  It 
would  appear,  that  small  particles  of  the  powder  inhaled  with  the  air 
induce  bronchitis,  and  at  the  same  time  affect,  in  a peculiar  manner, 
the  ramifications  of  the  pneumogastric  nerves,  so  as  to  give  occasion 
to  tliis  disorder.  A friend  of  the  author  suffered  excessively  when- 
ever he  had  occasion  to  handle  the  powder,  and  especially  if  he  were 
present  whilst  the  pulverisation  was  going  on.  Its  taste  is  bitter, 
subacrid,  mucilaginous,  and  very  nauseous. 

Ipecacuanha  yields  its  virtues  to  water,  and  still  more  to  alcohol, 
pure  or  diluted.  The  stronger  wines  equally  extract  them,  and 
hence  most  of  the  pharmacopceias  have  a wine  of  ipecacuanha.  The 
virtues  reside  essentially  in  an  active  principle,  which  was  first  sepa- 


often  termed  Emetia.  Pelletier’s  analysis  was  as 

Brown  Annulated  Ipecacuanha. 
Cortex.  Medituliiuin. 

follows. 

Red  do. 
Cortex. 

Emetia, 

16 

1.15 

14 

Odorous  fatty  matter. 

2 

traces 

2 

Wax, 

6 

— 

Gum, 

10 

5.00 

16 

Starch, 

Ligneous  matter. 

42 

20. 

18 

20 

66.60 

48 

Non-emetic  extractive. 

— 

2.45 

— 

Loss, 

4 

4.80 

2 

100 

100.00 

100 

The  emetia  in  this  analysis  is,  however,  the  impure,  and  it  was 
subsequently  found  by  Pelletier,  that  the  root  contains  only  about  1 
per  cent,  of  the  pure. 

Such  are  the  characters  of  the  officinal  ipecacuanha.  Other  ipe- 
cacuanhas have,  however,  been  described,  and  it  is  not  surprising, 
that  many  roots  should  have  been  substituted  for  the  oflScinal  variety. 
It  would  appear,  however,  that  they  are  but  little  known  in  the  trade 
of  this  countty  or  of  Europe.  It  is,  consequently,  not  necessary  to 
dwell  upon  them. 


IPECACUANHA. 


119 


Stri'ated  ipecacuanha  ^ black  Fig.  3. 

ipecacuanha^  is  from  psycho' tria 
emetica^  a native  of  Peru,  which 
was,  at  one  time,  supposed  to 
be  the  source  of  the ' true  ipe- 
cacuanha. This  would  appear 
to  be  sometimes  imported  into 
continental  Europe,  and  to  be 
confounded  with  the  dark  speci- 
mens of  the  true  ipecacuanha. 

Its  joints  however,  are  longer  ; 
and  the  surface  is  striated  longi- 
tudinally. Pelletier  found  it, 
on  analysis,  to  yield  9 percent, 
of  an  emetic  extract,  similar  to 
impure  emetia. 

Un'dulated^  White  ov  amyla' ce- 
ous  ipecacuanha  is  obtained  from 
different  species  of  Richard- 
so'nia,  which  inhabit  open  plains 
in  Brazil.  It  resembles  most 
the  true  root,  but  is  distinguished 
by  having  fewer  and  shallower 
annular  fissures,  larger  joints, 
and  the  central  woody  portion 
being  proportionally  much 
thicker.  Pelletier  found  it  to 
contain  5 or  6 per  cent,  of  an 
emetic  extract,  like  impure 
emetia,  and  a large  quantity  of 
starch.  Another  variety  of 
white  ipecacuanha  is  obtained  in  Brazil  from  ionid'ium  ipecacuanha^ 
or  vi'ola  ipecacuanha.  It  is  much  thicker  than  the  true  ipeca- 
cuanha, being  sometimes  as  large  as  the  little  finger,  having  only  a 
few  transverse  fissures,  distinct  joints  or  knots,  and  a thick  woody 
interior.  Pelletier  found  this  root  to  contain  about  5 per  cent,  of 
emetic  extract  similar  to  impure  emetia. 


Striated  Ipecacuanha  Root. 

. An  old  root,  with  a well- 
marked  intersection 


Undulated  Ipecacuanha 
Root. 

a Root  of  Richardsonia 
scabra. 

b.  Root  of  a Richard- 
sonia. (Pereira.) 


As  an  emetic,  ipecacuanha  acts  like  tartrate  of  antimony  and  pot- 
assa.  It  is  perhaps  the  safest  and  most  certain  of  the  indirect  emetics, 
and  although  it  is  supposed  to  be  — in  large  doses  — an  acro-narcotic 
poison,  the  author  has  never  known  a case,  in  which  such  symptoms 
have  presented  themselves.  Emetia,  when  injected  into  the  venous 
system  of  a dog,  excites  vomiting  in  the  first  instance,  and  afterwards 
coma,  which  ends  fatally. 

To  produce  full  emesis,  it  is  often  associated  with  tartrate  of  anti- 
mony and  potassa,  as  remarked  under  that  article  ; but  it  isfrequenty 
given  alone.  The  common  mode  is  to  administer  about  twenty 


120 


SPECIAL  EMETICS. 


Fig..  4 


grains  of  the  powder  in  warm  water  ; and  to  repeat  this  quantity 
every  fifteen  or  twenty  minutes  until  it  ope- 
rates ; drinking  freely  of  warm  water  or  of 
warm  chamomile  tea. 

When  the  object  is  to  excite  nausea,  from 
one  to  three  grains  may  be  prescribed  at  such 
intervals  as  may  be  deemed  advisable.  This 
dose  will  generally  be  sufficient  as  an  emetic 
for  children  of  two  or  three  years  old.  When 
it  does  not  operate  on  the  stomach,  both  it 
and  other  emetics  are  apt  to  affect  the  bowels  ; 
and  not  unfrequently  they  all  have  an  emeto- 
cathartic  operation. 

MUM  IPECACUA™,  IPECACUAFHA  WINE. — 
[Ipecac,  contus.  §ij  ; F?m,  Oij.)  This  prepa- 
ration may  be  used  in  the  same  cases  as  the 
antimonial  wine,  and  there  may  be  cases  in 
which  it  may  be  proper  when  the  former  is 
not  ; for  example,  the  antimonial  wine,  in 
particular  persons,  may  produce  griping  and 
intestinal  irritation,  whilst  the  wine  of  ipecac- 
cuanha  may  not ; and  conversely.  It  is  a 
very  safe  emetic  for  children.  The  dose  to  the  adult  is  one  fluid 
ounce  ; to  the  child  of  from  one  to  two  years  of  age  a tea-spoonful  or 
a fluidrachm. 


lonidium  Ipecacuanha  Root, 
(Pereira.) 


SYRTPUS  IPECACIMHI,  SYRUP  OF  IPECACUANHA.— (Jjoecac.  in  pulv, 
crass;  gj  ; Alcohol,  dilut.  Oj  ; Syrup ^ Oij.  Prepared  either  by  ma- 
ceration or  by  the  process  of  displacement.)  From  f.  ^j  to  f.  ^ij 
of  this  preparation  will  act  as  an  emetic,  but  it  is  not  much  used. 
It  is  more  convenient  for  children,  on  whom  it  operates  in  the 'dose 
of  from  f.5j  to  f.  5ij. 

EMET'IA. 

Emet'ia^  Emeti'na^  Em' eta  — as  already  remarked  — is  the  active 
principle  of  Ipecacuanha,  which  was  first  separated  from  it  in  1817 
by  Pelletier,  of  Paris.  It  is  not  officinal  in  the  Pharmacopoeias  of 
Great  Britain,  or  in  that  of  the  United  States,  but  has  been  received 
into  many  continental  Pharmacopoeias,  — as  the  Parisian,  Batavian, 
Hannoverian,  &c.  There  are  two  varieties  of  the  active  principle, 
which,  according  to  Magendie,  bear  the  same  relation  to  each  other 
as  moist  sugar  does  to  the  crystallised.  One  of  these  is  termed  the 
impure.,  the  other  the  pure.  To  obtain  the  former,  powdered  ipeca- 
cuanha is  digested  with  ether  to  dissolve  the  fatty  matter,  whence  it 
derives  its  disagreeable  odour,  and  which  possesses  no  emetic  virtue. 
When  the  powder  yields  nothing  more  to  the  ether,  it  is  exhausted 
by  means  of  alcohol ; the  alcohol  is  then  evaporated  in  a water-bath, 


GILLENIA. 


121 


and  the  residue  dissolved  in  cold  water.  It  thus  loses  some  of  the 
wax,  and  a little  of  the  fatty  matter  that  still  adhered  to  it.  It  is  then 
mixed  with  carbonate  of  magnesia,  whereby  it  loses  its  gallic  acid, 
is  redissolved  in  alcohol,  and  evaporated  to  dryness. 

To  obtain  pure  emetia,  magnesia  is  substituted  for  the  carbonate 
used  in  the  process  just  described,  in  such  quantity,  that  the  acid 
existing  in  the  liquid  may  be  neutralised,  and  that  which  is  asso- 
ciated with  the  emetia  be  separated  from  it.  Tiie  precipitate  of  mag- 
nesia and  emetia  must  now  be  washed  with  cold  water  to  remove 
the  colouring  matter,  which  is  not  combined  with  the  magnesia ; and 
after  being  carefully  dried  it  must  be  treated  with  alcohol,  which  dis- 
solves the  emetia.  The  emetia  obtained  by  the  evaporation  of  the 
alcohol  must  then  be  dissolved  in  a dilute  acid,  and  treated  with  pure 
animal  charcoal.  After  this  purification  it  must  be  precipitated  by  a 
salifiable  base. 

Impure  emetia  is  in  the  form  of  reddish  broAvn,  transparent  scales  ; 
is  almost  inodorous,  and  of  a bitter  taste.  It  is  very  deliquescent, 
and  soluble  in  water.  Pure  emetia  has  a white,  and  frequently 
somewhat  yellowish  appearance,  is  pulverulent,  and  does  not  deli- 
quesce like  the  impure.  It  is  but  little  soluble  in  cold  water  ; more 
so  in  warm.  It  dissolves  readily  in  ether  and  alcohol.  With  the 
acids  it  forms  crystallisable  compounds,  from  which  it  may  be  pre- 
cipitated by  galls,  which  are  the  best  agents  for  obviating  its  efiects 
in  an  overdose. 

Emetia  — the  impure  especially  — has  been  proposed  as  a subsitute 
for  ipecacuanha,  and  with  this  view  formulae  for  officinal  prepara- 
tions of  it  have  been  received  into  many  of  the  Pharmacopoeias  ot 
continental  Europe.  It  would  not  seem,  however,  that  much  advan- 
tage would  result  from  its  use,  and  it  certainly  is  far  more  expensive 
than  ipecacuanha  in  any  of  its  forms  of  preparation. 

The  dose  of  the  impure  emetia  is  a grain  or  a grain  and  a half, 
given  at  intervals  of  fifteen  or  twenty  minutes  until  it  vomits ; of  the 
pure  emetia,  from  a quarter  to  half  a grain. 

3.  GILLE'NIA. 

Gillenia  is  the  root  of  Gille'nia  trifolia' ta^  Spine' a trifolia' ta^  Indian, 
Physic^ Amer' ican  Ipecacuan' ha,  Beaumont  Root ; Sex.  Syst.  Icos- 
andria  Pentagynia  ; Nat.  Ord.  Rosaceae  ; — an  indigenous  herbaceous 
plant,  which  grows  throughout  the  United  States  to  the  east  of  the 
Alleghanies  from  Florida  to  Canada,  in  light  soils  and  in  shady  and 
moist  situations ; and  flowers  in  June  and  July.  The  root  is  gather- 
ed in  September. 

In  the  valley  of  the  Mississippi,  Gille'nia  stipula'cea  grows.  Its 
root  is  like  that  of  the  eastern  species,  and  is  said  to  possess  the  same 
properties. 

As  met  with  in  the  shops,  the  root  is  of  the  size  of  a small  goose- 
quill,  wrinkled  longitudinally,  with  occasional  transverse  fissures, 
VOL.  I.  — 11 


122 


SPECIAL  EMETICS. 


and  in  the  thicker  pieces  having  a somewhat  knotty  appearance, 
owing  to  indentations  on  one  side  corresponding  with  prominences 

on  the  other.  The  chief 
5.  properties  are  in  the  corti- 

cal portion,  which  has  a 
bitter  disagreeable  taste. 
Its  virtues  are  extracted  by 
the  same  menstrua  as  ipe- 
cacuanha. 

As  one  of  its  names  im- 
ports, its  medical  virtues 
resemble  those  of  ipeca- 
cuanha, for  which  it  is 
substituted  by  some.  It  is 
not,  however,  much  used, 
although  said  to  be  a mild 
and  satisfactory  emetic. 

The  dose  of  the  powder 
is  from  20  to  30  grains, 
repeated  like  ipecacuanha 
at  intervals  of  15  or  20 
minutes  until  it  operates. 

4.  SCILLA.  — SQUILL. 

Squill  is  the  bulb  of 
Scilla  or  Squilla  marit'ima^ 
Sea  on' ion ; Sex.  Svst. 
Hexandria  Monogynia; 
Nat.  Ord.  Liliacese ; 
which  grows  on  the  shores 
of  the  Mediterranean  — 
viz.  Spain,  France,  Italy, 
Sicily,  Greece  and  Africa. 
It  is  imported,  both  in  the 
fresh  and  dried  state,  but 
much  more  commonly  in 
the  latter ; an  incentive  to 
which  is,  that  in  England, 
and  we  believe  in  this 
country  also,  the  duty  on 
the  dried  bulb  is  no  higher 
than  that  on  the  fresh. 

'I  he  iVesh  bulb  is  pear-shaped,  and  consists  of  concentric  lamellaq 
the  outer  ones  of  which  are  thin,  membranous,  and  of  a brownish-red 
colour,  whilst  those  within  are  whitish,  thick,  fleshy  and  juicy. 

in  English  pharmacy,  two  kinds  of  squill  are  met  with,  — the 
wkite  and  the  red,  the  former  ol  which  is  preferred.  'I'he  average 


SCILLA. 


123 


weight  of  the  bulb  is  from  half  a pound  to  four  pounds,  but  they 
have  been  seen  weighing  ten  pounds  and  a half. 

The  fresh  bulb  is  kept  in  dry  sand  ; and  before  drying  it,  the  dry 
rind  is  removed  ; after  which  the  bulb  is  cut  transversely  into  thin 
slices,  and  dried  as  quickly  as  possible  with  a gentle  heat. 

The  dried  squill  of  the  shops  is  in  yellowish-white,  or  white, slightly 
diaphanous  pieces,  which  are  brittle  when  dry,  but  generally  flexible, 
owing  to  their  high  hygrometric  property  ; on  which  account,  it  ought 
to  be  kept  in  a dry  place,  or  in  well  stopped  bottles. 

Dried  squill  is  inodorous  ; and  of  a bitter,  nauseous,  extremely 
acrid  taste.  It  yields  its  virtues  to  water,  alcohol  and  vinegar.  Its 
best  solvents  are  dilute  alcohol  and  vinegar,  which  are  consequently 
used  in  various  officinal  formulae. 

Squill  has  been  subjected  to  analysis  by  different  chemists  ; but 
the  results  have  not  been  satisfactory,  and  it  is  not  admitted,  that 
the  active  principle  has  been  isolated. 

In  large  doses,  squill  belongs  to  the  acro-narcotic  class  of  vege- 
table poisons.  When  given  to  a less  extent,  it  operates  as  an 
emetic,  generally  producing  catharsis  also.  As  an  emetic,  it  is 
rarely  prescribed,  except  in  affections  of  the  respiratory  organs  ; 
over  which  — as  will  be  shown  under  the  head  of  Expectorants  — it 
is  conceived  to  exert  some  special  agency.  It  is  rarely,  however, 
given,  except  in  croup,  to  such  an  extent  as  to  produce  emesis  ; it 
is  exceedingly  uncertain  in  its  action,  and  the  vomiting  induced  by 
it  is,  at  times,  of  the  most  harsh  and  disagreeable  kind. 

The  dose  of  the  powdered  squill,  as  an  emetic,  is  from  six  to 
twelve  grains  ; but  it  is  scarcely  ever  prescribed  in  this  form  to  the 
adult ; and  to  children  one  of  the  following  preparations  is  selected. 
If  it  be  desirable  to  nauseate  by  it,  one  or  two  grains  may  be 
given  three  or  four  times  a day,  gradually  increasing  the  dose  until 
the  effect  is  induced. 

TmCTU'RA  SCILLJ],  TINCTURE  OF  SQUILL  — {ScilL  ^iv  ; Alcohol,  dilut. 
Oij.  Prepared  either  by  maceration  or  by  the  process  of  displace- 
ment.) As  a nauseant,  this  tincture  may  be  given  in  the  dose  of  30 
or  40  drops,  two  or  three  times  a day.  It  is  rarely,  however,  pre- 
scribed with  this  view,  being  generally  added  to  expectorant  mix- 
tures. It  is  not  administered  as  an  emetic. 

ACE'TUl  SCILLT,  VIN  EGAR  OP  SQUILL— cont.  ^iv  ; Acet.  de- 
stillat.  Oij.  ; Alcohol,  f.  ^j.  Prepared  either  by  maceration  or  by 
the  process  of  displacement.)  Two  ffuidrachms  will  usually  in- 
duce nausea.  The  alcohol  is  added  to  prevent  decomposition. 

OX'YMEL  SCILLiE,  OX'YMEL  OF  SQUILL. — Mel.  despumat.  -q^iij  ; Acet. 
Scill(Ej  Oij.  Reduce  to  the  specific  gravity  1.32.)  This  prepara- 
tion is  occasionally  given  to  children  labouring  under  croup  or  pul- 


124 


SPECIAL  EMETICS. 


monary  catarrh,  and  repeated  so  as  to  induce  vomiting.  The  dose 
for  this  purpose  is  a tea-spoonful  given  every  fifteen  or  twenty 
minutes. 


SYRTPUS  milM,  SYRUP  OF  SQUILL  — Scilla,  Oj  ; Sacchar.  }feij.) 
Given  as  a nauseant  and  emetic  in  the  same  cases  and  doses  as  the 
last. 


Fig.  10. 


SYR'UPUS  SCILL^  COMPOSdTUS,  COMPOUND  SYRUP  OF  SQUILL  — The  JV/e/. 
ScillcB  Compositum,  or  Compound  Honey  of  Squill  of  the  former 
Pharmacopoeias  of  the  United  States.  (Scill.  cont.  ; SenegcB  cont. 
aa  ,^iv. ; Antimon.et Potass.  Tarirat.gr.  xlviij.  ; Aquce  Oiv  ; Sacchar. 

If^iiiss.  The  water  is  poured  upon 
the  squill  and  senega.  It  is  then 
boiled  to  one-half,  and  strained  ; 
the  sugar  is  added,  and  the  whole 
evaporated  to  three  pints.  Whilst 
hot,  the  tartrate  of  antimony  and 
potasss  is  dissolved  in  it.  It  may 
also  be  prepared  by  the  process 
of  displacement.)  This  prepara- 
tion is  commonly  known  under 
the  name  of  Hive  Syrup  ; and  as 
a formula  of  the  kind  was  ori- 
ginally proposed  by  Prof.  J.  R. 
Coxe,  it  bears  the  name  of  Coxe^s 
Hive  Syrup.  It  is  much  used  in 
domestic  practice,  and  is  a fa- 
vourite remedy  in  croup  and 
every  form  of  pulmonary  ca- 
tarrh in  children.  The  dose  is 
from  ten  drops  to  a fluidrachm, 
according  to  the  age  of  the 
child,  repeated  every  fifteen  or 
twenty  minutes  until  it  operates. 
It  is  doubtful,  however,  as  else- 
where remarked,  whether  this  sy- 
rup have  any  virtues  as  an  eme- 
tic not  possessed  by  tartrate  of 
antimony  and  potassa,  or  ipeca- 
cuanha. 

5.  LOBE'LIA. 

Lohe'lia  Injla'ta,  Indian  To- 
had  co,  or  Emdtic  Weed ; Sex. 
Syst.  Pentandria  Monogynia : 
Lobelia  inflata.  Nat.  Order,  Lobeliaccce  ; is  an 

indigenous  plant,  which  is  a common  weed  throughout  the  United 


SINAPIS. 


125 


States,  beginning  to  flower  about  the  end  of  July  and  terminating 
on  the  occurrence  of  frost.  The  plant  is  collected  in  August  or  Sep- 
tember. 

When  chewed  it  produces  the  same  effects  as  tobacco.  Like 
it,  too,  it  appears  to  contain  an  essential  oil  on  which  its  odour 
depends,  and  an  acrid  or  alkaline  principle,  to  which  its  effects 
on  the  system  have  been  considered  to  be  ascribable.  To  this  acrid 
principle,  Mr.  Procter,  of  Philadelphia,  who  separated  it,  gave  the 
name  Lobelina.  He  found  that  the  seeds  contained  at  least  twice  as 
much  in  proportion  as  the  whole  plant,  which  yielded  only  one  part 
in  500. 

Lobelia  imparts  its  virtues  to  the  same  menstrua  as  ipecacu- 
anha. It  is  a powerful  acro-narcotic,  and  has,  therefore,  to  be  ad- 
ministered with  caution.  On  this  account  it  is  not  often  given,  in 
regular  practice,  as  an  emetic.  The  dose  of  the  powder  is  from  five 
grains  to  twenty,  repeated  until  it  operates. 

TINCTU'Rl  LOBE'LkT,  TINCTURE  OF  LOBE'LIA.  {Lobel.  Eiv  ; McohoL  dilut. 
Oij  ; prepared  either  by  maceration  or  by  the  process  of  displace- 
ment.) The  full  dose  of  the  tincture,  as  an  emetic,  is  about  half  a 
fluid  ounce  ; but  it  is  sometimes  prescribed  as  an  emetic  and  nar- 
cotic in  asthmatic  cases,  in  the  dose  of  f.  5j.  or  f.  ^ij,  until  vomiting 
is  induced. 


6.  SINA'PIS.— MUSTARD. 

Mustard  is  the  seed  of  Sina'pis  nigra,  and  S.  alba;  Sex.  Svst. 
Tetradynamia  siliquosa  : Nat.  Ord.  Cruciferae  ; plants  which  are 
indigenous  in  Europe  ; but  cultivated  there  as  well  as  in  this 
country,  and  which  flower  in  June.  It  is  kept  in  the  shops,  both  in 
seed,  and  in  fine  powder,  as  prepared,  on  the  large  scale,  for  culi- 
nary purposes. 

Black  mustard  seed  are  small  and  roundish  ; of  a reddish  or 
blackish-brown  colour  externally,  and  yellow  internally.  When  en- 
tire, they  are  inodorous  ; but  when  bruised,  the  odour  is  very  pun- 
gent; taste,  bitterish  and  acrid.  The  seeds  of  white  mustard  are 
larger,  and  of  a somewhat  less  pungent  taste.  Both  varieties  afford 
a*' yellow  powder,  of  a somewhat  unctuous  appearance.  When 
bruised  or  powdered,  they  communicate  their  active  properties  to 
water,  but  only  slightly  to  alcohol. 

Both  black  and  white  mustard  seeds  have  been  repeatedly  sub- 
jected to  chemical  analysis,  and  the  results  are  interesting  to  the 
organic  chemist,  but  very  little  so  to  the  therapeutist.  When  black 
mustard  seed  are  subjected  to  pressure,  about  28  per  cent,  of  fixed 
oil  is  obtained,  which  has  a faint  smell  of  mustard,  and  a mild  oily 
taste,  and  which  has  been  used  as  a cathartic  and  anthelmintic.  On 
distillation  with  water,  a volatile  oil  is  obtained,  which  is  exceed- 
ingly acrid,  and  contains  a portion  of  sulphur.  This  oil,  it  appears, 
11* 


126 


SPECIAL  EMETICS. 


does  not  pre-exist  in  the  seeds,  but  is  produced  by  the  action  of 
water. 

White  mustard  seeds  contain  more  fixed  oil  than  the  black,  but 
they  cannot  be  made  to  yield  any  volatile  oil.  Their  activity  ap- 
pears to  be  owing  to  a non-volatile  acrid  substance,  which  does  not 
exist  ready  formed  in  the  seeds,  but  is  readily  formed  in  them  under 
certain  conditions.  It  was  affirmed  many  years  ago,  by  MM.  Trou- 
peau  and  Blanc,  that  the  irritating  property  of  black  mustard  is  dimi- 
nished by  the  addition  of  vinegar,  which  is  very  often  used  in  form- 
ing sinapisms  ; and  that  a mixture  of  concentrated  acetic  acid  in 
certain  proportions  with  black  mustard  powder  is  wholly  inert, 
although  either  one  or  the  other  would  act  as  a powerful  excitant,  if 
used  — the  former  with  water,  and  the  latter  undiluted.  The  vine- 
gar and.  acetic  acid,  in  these  cases,  have  the  effect  of  preventing 
the  development  of  the  acrid  volatile  oil.  Some  interesting  expe- 
riments have  been  made  on  this  subject,  by  two  recent  writers  on 
therapeutics  and  materia  medica,  — MM.  Trousseau  and  Pidoux,  who 
found  : First.  That  there  was  no  notable  difference  between  mustard 
pounded  eight  days  before  it  was  used,  and  that  which  had  been 
pounded  five  months  before.  Secondly.  That  a sinapism  prepared 
with  hot  water,  acts  more  rapidly  than  one  prepared  with  cold  water  ; 
but  at  the  end  of  a few  minutes  this  difference  no  longer  exists. 
Thirdly.  That  mustard  mixed  with  water  acts  with  greater  energy 
than  that  which  is  mixed  with  common  vinegar,  weak  acetic  acid, 
and  concentrated  acetic  acid  ; and  that  reciprocally,  acetic  acid, 
mixed  with  mustard,  loses  of  its  activity.  These  gentlemen  add, 
that  the  admixture  with  vinegar  appeared  to  have  no  effect  on  En- 
glish mustard  — a discrepancy  which  they  express  themselves  unable 
to  explain.  It  has  been  suggested,  however,  by  Dr.  Pereira,  that 
this  may  perhaps  be  referable  to  the  fact  that  common  English  flour 
of  mustard  contains  pod  pepper,  the  active  principle  of  which  {cap- 
sicin)  is  soluble  in  vinegar.  It  does  not  appear  that  the  same  dete- 
riorating influences  are  exerted  on  white  mustard. 

The  medical  properties  of  mustard,  are  those  of  an  acrid  excitant. 
When  it  meets  with  water — as  already  remarked  — volatile  oil  is 
developed,  which  is  the  occasion  of  the  acrid  vapour,  that  arises 
when  flour  of  mustard  and  hot  water  are  mixed  together. 

Mustard  seeds  bruised,  or  the  powder  in  the  dose  of  a large  tea- 
spoonful, will  generally  operate  as  an  emetic,  and  have  been  es- 
teemed useful,  where  it  has  been  considered  advisable  to  rouse  the 
sensibility  of  the  stomach, — as  when  narcotic  poisons  have  been 
taken  in  malignant  cholera,  and  in  certain  forms  of  ptaralysis.  It  is 
more  frequently,  however,  diffused  in  warm  water,  and  administered 
to  aid  the  operation  of  other  emetics. 

7.  TAB'ACUM. —TOBAC/CO. 

The  leaves  of  JYicotia'na  Tah'acum  — Sex.  Syst.  Pentandria  Mo- 
nogynia  ; Nat.  Ord.  Solaneee  or  Solanaceso  — are  the  officinal  por- 


TABACUM. 


127 


tion  of  the  plant,  so  well  known  owing  to  its  extensive  cultivation  in 
this  country,  and  to  its  employment  in  most  parts  of  the  globe.  It 
imparts  its  properties  to  both  water  and  alcohol  ; but  long  boiling 
destroys  them,  and,  accordingly,  the  extract  is  devoid  of  all  the 
virtues  of  the  plant. 

Tobacco  has  been  subjected  to  analysis  by  many  chemists ; the 
result  of  which  would  seem  to  show,  that  the  two  main  active  prin- 
ciples are  — a peculiar  oily-like  alkaloid,  called  JYicoti'na,  or  JYico'- 
tia  ; and  a camphoraceous  volatile  oil  termed  JYico' tianin,  Concrete 
volatile  oil  of  tobacco^  and  Tobacco  camphor.  Nicotia  belongs  to  the 
same  class  of  principles  as  conia,  and  closely  resembles  it  in  chemi- 
cal properties.  It  appears  to  be  the  most  active  of  the  constituents. 

When  tobacco  is  distilled  at  a higher  temperature  than  that  of 
boiling  water,  an  empyreumatic  oil  is  formed,  under  new  combina- 
tions, which  is  most  virulently  poisonous.  This  oil  is  formed  in  the 
pipe  of  the  smoker,  and  is  associated  with  nicotia. 

In  large  doses,  tobacco  is  one  of  the  most  violent  acro-narcotic 
poisons.  In  smaller,  it  occasions  vomiting  accompanied  by  the 
most  deadly  sickness  and  sedation.  Hence,  its  use  in  cases  where 
great  relaxation  is  necessary.  Its  powerful  nauseant  and  emetic 
operation,  as  well  as  its  effect  on  the  nervous  system,  is  well  seen 
in  those  who  attempt  to  chew  or  to  smoke  it  for  the  first  time.  Even 
when  given  in  glyster,  or  ap})lied  to  abraded  surfaces,  it  has  caused 
death  ; and  a tobacco  cataplasm  applied  to  the  pit  of  the  stomach 
has  succeeded  in  inducing  nausea  and  vomiting  ; more  especially 
where  other  emetics  have  been  taken  previously. 

As  a nauseant,  and  therefore  relaxant,  it  has  been  employed  in 
various  forms  of  colic,  constipation  and  strangulated  hernia  ; and  its 
operation  is  generally  attended  with  nausea  and  giddiness.  In  these 
cases,  it  is  thrown  into  the  rectum  either  in  the  form  of  infusion,  or 
of  smoke  ; and  in  strangulated  hernia  especially,  it  has  proved  effec- 
tive, after  blood-letting,  tartrate  of  antimony  and  potassa,  and  other 
sedative  relaxants  had  been  used  in  vain.  In  like  manner  it  has 
been  prescribed  in  retention  of  urine,  tetanus  and  other  spasmodic 
diseases,  — wherever,  in  short,  it  is  important  to  produce  powerful 
sedation,  or  to  relax  spasms.  Still  the  fatal  results,  occasionally 
supervening  on  its  employment,  must  be  borne  in  mind,  and  it  must 
not  be  used  except  in  cases  which  have  resisted  other  means.  This 
is  probably  the  cause,  why  both  the  physician  and  the  surgeon  pre- 
scribe it  rarely. 

Tobacco  has  been  given  as  an  emetic,  in  the  form  of  snuff, — five 
or  six  grains  constituting  a sufficient  dose;  but  it  is  rarely  prescribed 
in  this  shape. 

INFU'SlJlI  TAB'ACI,  INFESION  OF  TOBAC  CO. — ( Ta&ac.  5j.  ; Aqu(E  bul- 
lient.  Oj.)  This  is  never  used  except  as  an  enema  to  produce  re- 
laxation. It  is  safer  to  inject  only  one  half ; and  if  the  relaxant 
effects  be  not  induced  in  half  an  hour,  to  throw  up  the  remainder. 


128 


SPECIAL  EMETICS. 


It  must  be  borne  in  mind,  that  a smaller  quantity  than  half  a drachm 
has  proved  fatal. 


VmUM  TAB'ACI,  WINE  OF  TOBACCO— (Taftac.  concis.  Ey;  Vini.  Oj.) 
This  preparation  has  been  more  frequently  employed  as  a diuretic,  but 
it  is  capable,  in  repeated  doses  of  thirty  or  forty  drops,  of  inducing 
nausea.  A cataplasm  is  sometimes  made  of  common  snuff  and  ce- 
rate, and  has  been  applied  to  the  throat  and  breast  in  cases  of  croup; 
and  Dr.  Wood  states,  that  one  of  the  worst  cases  of  spasm  of  the 
rima  glottidis  which  he  had  seen,  and  which  had  resisted  powerful 
depletion  by  the  lancet,  yielded  to  the  application  of  a tobacco  cata- 
plasm to  the  throat. 


Fig.  7. 


The  infusion  of  tobaccohas, 
likewise,  been  employed  with 
advantage  as  a bath  in  tetan- 
ic and  similar  neuropathic 
affections,  and  also  the  cigar 
in  the  case  of  those  who  have 
been  unaccustomed  to  its  use. 


8.  SANGUINA'RfA.  — BLOOD- 
ROOT. 


tues  of  the  root. 


Sanguinaria  is  the  root 
of  Sanguina'ria  Canaden'sis, 
Blood-root^  Puccoo7i,  Indian 
Painty  Tur' meric;  Sex.  Syst. 
Polyandria  Monogynia;  Nat. 
Ord.  Papaveraceae ; an  herba- 
ceous perennial  plant,  which 
flowers  early  in  spring,  and 
grows  abundantly  in  every 
part  of  the  United  States. 

The  root,  which  is  the  only 
officinal  portion,  when  dried, 
is  in  flattened  pieces,  much 
wrinkled  and  contorteil.  The 
fracture  is  spongy  and  une- 
A'^en,  — its  surface  being  at  first 
bright  orange,  but  becoming, 
by  exposure,  of  a dull  browm 
colour.  It  has  a bitterish  acrid 
taste,  and  imparts  its  virtues 
to  water  and  alcohol.  An 
active  principle  — Sanguina- 
rwe-— has  been  obtained  from 
it,  wdiich  is  alkaline,  and  con- 
sidered to  possess  all  the  vir- 
It  is  said  to  lose  its  virtues  rapidly  by  keeping. 


ANTHEMIS. 


129 


Bloodroot  is  an  acrid  emetic  ; and,  in  large  doses,  belongs  to  the 
class  of  acro-narcotic  poisons.  It  is  not  often  employed  as  an  emetic. 
The  dose  of  the  powder,  with  this  view,  is  from  ten  to  twenty  grains. 
It  is  recommended,  that  it  should  be  taken  in  pill  by  preference, 
in  consequence  of  the  great  irritation  of  the  throat  produced  by  the 
powder  when  swallowed.  (Wood  and  Bache.)  It  may  also  be  pre- 
scribed in  infusion.  (Sanguinarice  ^ss  ; Aq.  fervent.  O].)  of  which 
the  dose  may  be  a table-spoonful  or  two. 

^ TlNCTURl  SANGUINA™,  TINCTURE  OF  BLOODROOT.  — cont. 

,^iv  : Alcohol,  dilut.  Oij.  Prepared  by  maceration  or  by  the  process 
pf  displacement.)  The  dose  as  an  emetic  is  f.  ^iij.  to  f.  5iv.  but  it 
Is  not  often  administered  as  such. 

9.  AN'THEMIS.— CHAM'OMILE. 

Chamomile  is  the  flower  of  ./In'themis  no'hilis ; Sex.  Syst.  Syn- 
genesia  Polygamia  Superflua ; Nat.  Ord.  Compositae  Corymbiferm, 
a plant  which  is  indigenous  almost  every  where  in  temperate  Europe. 
The  flowers  become  double  by  cultivation  ; and  hence  those  which 
are  found  in  the  shops,  and  which  are  imported  from  Germany  and 
England,  are  of  this  character.  It  is  cultivated  largely  around  London 
for  the  market  of  that  city. 

The  odour  of  cha- 
momile is  powerful, 
fragrant  and  grateful, 
and  the  taste  warm 
and  bitter.  It  imparts 
its  virtues  to  both 
water  and  alcohol,  the 
former  of  which,  at 
the  boiling  tempera- 
ture, extracts  nearly 
one -fourth  of  its 
weight.  Its  most  im- 
portant constituents 
are, — volatile  oil, 
bitter  extractive  and 
tannic  acid ; and  as 
the  excitant  proper- 
ties are  greatly  de- 
pendent upon  the  first 
of  these,  decoction  is 
an  objectionable  form, 
where  it  is  desirable 
to  have  a preparation 
containing  all  the  vir- 
tues of  the  drug. 

With  the  view  of  producing  emesis,  but  one  preparation  of  cha- 


Fig.  8. 


Apocynum  Androsscmifolium. 


130 


SPECIAL  EMETICS. 


momile  is  ever  given,  — the  tepid  infusion;  and  it  is  rarely  pre- 
scribed except  with  the  view  of  aiding  the  action  of  other  emetics, 
or  in  cases  where  there  is  a disposition  in  the  stomach  to  relieve 
itself  spontaneously. 

INFU'SUM  ANTITEM'imS,  INFU'SION  OF  CnAM'OMlLB,  {Anthemid.  .^ss  ; Aquce 
hullient.  Oj.  Dose,  as  an  emetic,  f.  5iv.  The  infusion — Chamo- 
mile tea  — is  generally,  however,  made  extemporaneously  in  domestic 
practice. 

10.  HYDRAR'GYRI  SULPHAS  FLA VUS  — YELLOW  SULPHATE  OF 

MER'CURY. 


This  salt  of  Mercury,  called  also  Suhsulph' ate  of  Mer’cury  and  Tur- 
pj„  9^  peth  Mine'ral^  is  ob- 

tained by  throwing  a 
sulphate  of  mercury 
into  boiling  water.  It 
is  a lemon -yellow 
powder,  almost  inso- 
luble in  water  ; dis- 
solving in  about  2000 
parts  of  cold  water, 
and  in  about  600 
parts  of  boiling  wa- 
ter. 

Yellow'  sulphate  of 
mercury  is  in  large 
doses  a violent  cor^ 
rosive  poison.  It  is 
occasionally,  but  rare- 
ly,  given  as  an  eme- 
tic ; its  operation  be- 
ing very  severe,  and 
at  times  followed  by 
ptyalism.  Exciting 
greatnausea  and  pow- 
erful retching, it  would 
be  much  employed  in 
cases  in  w^hich  a strong 
revulsion  is  indicat- 
ed, were  it  not  that 
its  action  is  so  harsh, 
and  unmanageable. 

The  dose  as  an  eme- 
tic is  from  tw  o to  five 
ins 


EUPHORBIA  COROLLATA. 


131 


11.  SO'DII  CHLO'RIDUM  — CHLORIDE  OF  SO'DIUM. 

When  common  salt  — whose  properties  are  described  under  the 
liead  of  Cathartics — is  taken  in  the  dose  of  a table-spoonful  or 
more,  it  excites  vomiting ; and  during  the  visitations  of  epidemic 
cholera,  it  was  preferred  by  some  practitioners  to  other  emetics.  It 
has  also  been  given  in  cases  of  narcotic  poisoning,  where  neither  the 
stomach-pump  nor  other  emetics  were  at  hand. 

A few  other  indigenous  substances  that  act  as  emetics  have  been 
admitted  into  the  secondary  list  of  the  Pharmacopoeia  of  the  United 
States,  viz : 

12.  Apoc"ynum  androsa:mifo'lium,  Dogshane ; Sex.  Syst.  Pen- 
tandria  Digynia  ; Nat.  Ord.  Apocynacem  ; a plant  which  flourishes 
in  every  part  of  the  Union,  flowering  in  June  and  July,  and  is  emetic 
in  the  close  of  thirty  grains  of  the  dried  root. 

13.  Ascle'pias  Incarna'ta,  F/esA  co/owrec?  Ascle'pias;  Sex.  Syst. 
Pentandria  Digynia  ; 

Nat.  Ord.  Asclepia- 
dacem;  flowering  from 
June  to  August.  The 
root  has  been  used  as 
an  emetic  and  cathar- 
tic. 

14.  Erythro'nium, 

Dog’’ s Tooth  Violet ; 

Sex.  Syst.  Hexandria 
Monogynia  ; Nat. 

Ord.  Liliacese;  which 
grows  throughout  the 
Northern  and  Middle 
states ; flowering  in 
April  and  May  ; the 
root  and  herb  being 
officinal.  Dose,  as 
an  emetic,  twenty  or 
thirty  grains  of  the 
recent  bulb. 

15.  Euphor'bia  Co- 
rolla'ta.  Blooming 
or  Large  flowering 
Spurge^  Milk  weed ; 

Sex.  Syst.  Dodecan- 
dria  Trigvnia  ; Nat. 

Ord.  Euphorbiaceae ; which  grows  in  various  parts  of  the  United 


Fig.  10. 


•B1BIIO4O0  BiqjoJidng 


132 


CATHARTICS. 


States,  flowering  in  July  and  August ; and  the  dried  root  of  which 
is  emetic  in  the  dose  of  from  ten  to  fifteen  grains. 

16.  Euphor'bia  Ipecacuan'ha,  Ipecacuan'ha  Spurge^  Amer'ican 
Ipecacuan' ha^  which  flourishes  in  the  Middle  and  Southern  states, 
blooming  from  May  to  August ; and  the  dried  root  of  which  is  emetic 
in  the  dose  of  from  ten  to  fifteen  grains. 

17.  Phytolac'cai:  Radix,  Poke  root  — the  root  of  Phytolac’ca 
Decan! dra;  Sex.  Syst.  Decandria  Decagynia;  Nat.  Ord.  Phytolacese; 
which  is  emetic  in  the  dose  of  from  ten  to  thirty  grains  ; but  is  slow 
and  protracted  in  its  operation,  apt  to  act  upon  the  bowels,  and 
in  very  large  doses  to  induce  symptoms  of  acro-narcosis.  It  is  there- 
fore not  olten  used. 


II.  CATHARTICS. 

Stxox.  Df^jectoria,  Eccathartica,  Hypactica,  Lapactica,  Jlpocathartica,  CoprocrUica. 

Definition  of  cathartics — Effects  they  are  capable  of  inducing — Organs  on  which  they 
act — Divided  into  laxatives  and  purgatives — Drastics — Abuse  of  eathartics — Clys- 
ters— Suppositories — Therapeutical  application — In  fevers — In  inflammatory  disor- 
ders— In  hemorrhage — In  the  neuroses — In  dropsies,  &c.  S'pecial  cathartics. 

The  simplest  definition  of  cathartics  is — ^‘agents  that  increase 
the  number  of  alvine  evacuations.”  Certain  writers  on  Therapeutics 
have  endeavoured  to  incorporate  in  the  definition  their  modus  oper~ 
andi;  and,  in  a modern  work,  the  definition  is  still  farther,  and  with 
less  propriety,  extended, — so  as  to  include  other  effects  which 
they  may  or  may  not  induce.  Thus,  the  Messrs.  Schroff  define  them 
to  be;  — “Medicines,  which,  by  augmenting  the  secretion  and  pe- 
ristole of  the  intestinal  tube,  occasion  the  evacuation  by  the  anus  of  ac- 
cumulated and  noxious  matters:”  but  it  is  obviously  not  necessary 
for  the  induction  of  catharsis,  that  there  should  be  any  accumula- 
tion — physiological,  pathological,  or  noxious — in  the  bowels.  The 
definition  is,  consequently,  faulty. 

There  is  no  class  of  medicinal  agents  possessed  of  more  valuable 
properties,  and  none  more  abused.  Exposed,  as  the  digestive  or- 
gans are,  to  the  most  heterogeneous  and  often  irritating  substances, 
and  liable  to  have  their  tone  injured  by  alternations  of  stimulation, 
and  the  opposite  condition,  accumulations  of  food  as  well  as  of  secre- 
tions are  apt  to  occur,  which  demand  the  use  of  cathartics : their 
effect,  too,  is  not  confined  to  the  mucous  membrane  of  the  alimentary 
tube  : through  the  nerves,  it  is  propagated  elsewhere,  so  as  to  re-act 
on^organs,  situate  at  a distance  from  the  seat  of  the  impression. 

To  fully  comprehend  the  effects  which  cathartics  are  capable  of 


CATHARTICS.  133 

inducing,  it  may  be  well  to  consider  briefly  the  organs  and  tissues  on 
which  their  operation  is  immediately  exerted. 

The  mucous  coat  of  the  small  and  large  intestines  is  an  extension 
of  that  of  the  stomach,  and,  with  some  modification,  of  that  of  the 
supra-diaphragmatic  portion  of  the  digestive  tube  ; and  this,  again, 
may  be  looked  upon  as  an  extension  of  the  cutaneous  envelope  of 
the  body.  Like  the  mucous  lining  of  the  stomach,  that  of  the  small 
intestines  is  a part  of  the  surface  of  relation,  and  impressions  made 
upon  it  are  probably  conveyed,  with  equal  facility,  to  the  great 
nervous  centres.  Hence  it  is,  that  it  has  been  regarded  by  M. 
Broussais  as  the  seat  of  many  important  diseases,  of  a febrile  charac- 
ter especially. 

In  the  mucous  coat  are  situate  many  of  those  mucous  follicles, 
which,  in  consequence  of  their  having  been  described  by  Brunner, 
Peyer,  and  Lieberkiihn,  have  been  called  after  those  observers. 
Their  function  is  to  secrete  mucus  for  lubricating  the  mucous  mem- 
brane ; but,  of  late,  their  importance  in  the  economy  has  been  ex- 
aggerated by  some  ; and,  as  has  been  previously  remarked,  they  have 
been  looked  upon  as  the  seat  of  many  of  those  ataxic  and  adynamic 
fevers,  which  Broussais  refers  to  the  mucous  membrane  generally. 
It  does  not  appear  probable,  that  these  small  follicles  can  be  so  inti- 
mately associated,  in  their  morbid  derangements,  with  the  great  vital 
organs,  as  to  give  occasion  to  the  diseases,  that  have  been  ascribed 
to  them.  Their  function  seems  to  be  similar  to  that  of  the  sebaceous 
follicles  of  the  cutaneous  envelope,  and  they  have  not  perhaps  any 
great  agency  in  the  causation  of  disease.  Frequently,  on  dissection, 
they  are  found  considerably  enlarged,  and  this  is,  doubtless,  often 
owing  to  their  forming  part  of  the  lining  of  the  tube,  as  Broussais 
has  suggested.  At  other  times,  they  are  enlarged  and  ulcerated,  and 
thus  become  one  of  the  expressions  of  typhoid  fever,  but  not  the 
essence  of  it ; as  the  eruption  of  measles  or  scarlatina  is  only  one  of 
the  expressions  or  manifestations  of  those  diseases. 

The  mucous  membrane,  besides  the  secretion  from  the  follicles, 
exhales  the  ordinary  halitus  of  the  mucous  membranes,  and  the  two 
together  are  to  a considerable  amount.  The  daily  quantity,  indeed, 
of  the  liquor  entericus  or  succus  intestinalis^  as  it  has  been  called,  was 
estimated  by  Haller  at  probably  far  beyond  the  truth. 

In  addition  to  this  humour,  the  upper  part  of  the  small  intestine 
receives  the  secretions  from  two  important  organs, — which,  from 
their  presumed  agency  in  chylosis,  have  been  termed  assistant  chylo- 
poietic  viscera^  — the  liver,  and  the  pancreas,  whose  ducts  open  to- 
gether. 

From  the  upper  portion  of  the  small  intestine  more  especially,  the 
chyliferous  vessels  arise  : — this  part  of  the  tube  must  therefore  be 
regarded  as  the  great  seat  of  chylosis  or  chylification. 

It  is  not  until  the  faces  have  attained  the  lower  part  of  the  small 
intestine,  or  the  commencement  of  the  large,  that  they  attain  the  full 
VOL.  I. — 12 


134 


CATHARTICS. 


faecal  odour.  This  is  not  produced  altogether  by  the  reaction  of  the 
elements  of  the  food  upon  each  other,  but  by  a peculiar  secretion  ; 
so  that  alvine  discharges,  possessed  of  the  faecal  odour,  may 
take  place,  even  when  little  or  no  food  has  been  taken  ; and,  in  the 
course  of  febrile  affections,  it  becomes  important  to  remove  those, 
should  constipation  arise,  as  they  are  capable  of  inducing  as  much 
irritation  as  if  they  were  the  product  of  the  digestion  of  alimentary 
matter.  So  long  as  life  persists,  secretions  are  poured  into  the  ali- 
mentary tube  throughout  its  whole  extent  from  the  lining  mem- 
brane, as  well  as  from  the  liver  and  pancreas;  and  if  these  are  per- 
mitted to  remain  in  the  canal,  they  become  the  foyers  of  irritation, 
and  mischief.  The  argument,  often  urged,  — that  it  is  not  neces- 
sary for  the  bowels  to  be  kept  open  in  morbid  cases,  because  no 
food  has  been  taken,  — is  therefore  erroneous. 

Although  in  the  upper  portion  of  the  small  intestines  an  arrange- 
ment of  the  mucous  coat  exists,  calculated  to  detain  somewhat  the 
aliment  in  its  course  downwards,  and  to  extend  the  surface  for  the 
origin  of  chyliferous  vessels,  in  no  part  of  its  extent  does  it  pre- 
sent the  character  of  a reservoir.  The  opposite  to  this  is  the  case 
with  the  large  intestine.  Its  saccated  arrangement  clearly  shows  it 
to  be  destined  for  the  detention  of  the  faecal  matters,  until  they  have 
accumulated  to  such  an  extent  as  to  give  rise  to  the  necessity  for 
the  act  of  defecation.  In  these  saccated  portions,  the  faeces  are 
occasionally  retarded,  become  indurated,  and  adhere  to  the  mucous 
membrane,  so  as  to  excite  irritation;  and,  when  evacuated,  they  are 
in  the  form  of  small  rounded  masses,  to  which  the  name  scyhala  has 
been  given. 

The  whole  of  the  intestinal  canal  is  more  or  less  endowed  with 
the  vermicular,  oscillatory  motion,  which  has  been  called  peristole^ 
or  peristaltic  action.  This  motion  is  under  the  influence  of  the 
ganglionic  nerves,  through  w^hich  the  muscular  coat  of  the  tube  is 
excited  to  contraction,  and  the  degree  in  which  contraction  occurs 
is  greatly  connected  with  the  mode  in  which  the  function  of  diges- 
tion is  accomplished. 

Lastly,  it  is  important  to  keep  in  view,  that  various  organs  are 
contiguous  to  the  alimentary  tube,  whose  functions  are  susceptible 
of  modification  by  agents  that  affect  it.  Reference  has  already  been 
made  t6  the  liver,  and  pancreas  ; and  it  will  be  found,  that  the* 
uterus  can,  in  this  way,  be  considerably  modified  in  its  actions. 

As  regards  the  effects  of  cathartics  on  the  intestinal  canal,  much 
difference  exists  according  to  the  nature  of  the  agent,  and  the  dose 
in  which  it  is  exhibited. 

When  the  lining  membrane  is  but  slightly  stimulated,  chylosis 
may  be  augmented,  and  a laxative  tendency  be  induced  ; if  it  be 
more  stimulated,  the  exhalation  from  it  may  be  increased,  and  ’ the 
irritation  be  extended  by  the  sympathy  of  contiguity  to  the  muscular 


DIGESTIVE  APPARATUS. 


135 


coat,  so  that  there  may  be  a slight  increase  in  the  peristole;  and  if 
the  specific  stimulation  be  yet  greater,  both  the  exhalation  and  the 
peristole  may  be  largely  augmented. 

The  effect  of  a mild  cathartic  may  be  almost  wholly  restricted  to 
the  evacuation  of  the  tube,  and  but  little  effect  be  exerted  on  other 
organs,  or  on  the  general  system.  The  first  evacuations  which  re- 
sult from  its  operation  consist  merely  of  the  contents  of  the  intes- 
tines : those  that  follow  are  mixed  with  the  secretions  of  the  canal, 
and  of  the  liver  and  pancreas,  with  the  drinks  that  have  been  taken  ; 
and  at  times,  fluids  — as  soups — maybe  readily  detected  in  the 
discharges.  Yet,  as  the  appearance  of  an  unusual  quantity  of  bile, 
in  the  matters  ejected  by  vomiting,  may  merely  be  an  evidence  that 
the  excitement  accompanying  emesis  has  caused  a greater  secretion 
of  bile,  so  — it  must  be  borne  in  mind  — the  alvine  discharges  may 
assume  an  unhealthy  bilious  character  under  the  operation  of  a 
cathartic,  owing  solely  to  the  irritation  it  induces  in  the  various  se- 
cretory organs  of  the  digestive  apparatus.  When  the  mild  chloride 
of  mercury,  for  example,  is  administered  as  a cathartic,  it  irritates 
the  lining  membrane  of  the  duodenum,  and  this  irritation  extends 
along  the  biliary  ducts  to  the  liver,  the  secretion  from  which  is  aug- 
mented. At  the  same  time,  it  irritates  the  different  follicles  of  the 
canal,  and  the  exhalants  generally,  so  that  evacuations  are  occa- 
sionally induced  by  it,  which  resemble  chopped  spinach,  and  which 
are  regarded  by  some  as  indicating  that  it  has  succeeded  in  in- 
ducing a new  action  in  the  mucous  lining  of  the  digestive  tube.  It 
can,  hence,  be  understood,  that  after  the  operation  of  calomel,  or  of 
any  purgative,  whose  action  is  chiefly  exerted  on  the  upper  portion 
of  the  intestines,  there  may  be  a greater  quantity  of  bile  in  the  eva- 
cuations, without  our  being  justified  in  inferring,  that  the  individual 
is  bilious;  and  that  the  increased  flow  of  bile  is  occasioned  by  the 
purgative  may  be  proved  by  discontinuing  its  use  for  some  days, 
when  the  signs  of  bile  in  the  evacuations  will  cease,  and  be  repro- 
duced, when  it  is  resumed. 

It  has  been  mentioned,  that  the  mild  chloride  of  mercury  affects 
the  upper  part  of  the  intestinal  canal ; and  the  same  may  be  said  of 
rhubarb,  colocynth,  &c.  There  is,  indeed,  a singular  preference  on 
the  part  of  different  cathartics  for  different  portions  of  the  tube  ; some, 
— as  the  articles  enumerated,  — acting  on  the  upper  part ; others,  — 
as  aloes,  — on  the  large  intestines,  and  especially  on  the  colon  and 
rectum  ; and  others,  — as  the  saline  and  oily,  — affecting  the  whole 
tract  of  the  intestines.  Accordingly,  a selection  may  be  made  so  as 
to  suit  the  particular  view  of  the  practitioner.  At  times,  too,  it  is 
desirable  to  act  on  other  organs  through  the  intestinal  canal,  by 
means  of  sympathy  ; as  when  we  wish  to  affect  the  liver  or  pan- 
creas, — in  which  case  cathartics  are  chosen,  that  act  upon  the  part 
of  the  tube  into  which  their  ducts  enter,  — or  the  uterus,  when  one 
is  selected  that  acts  by  preference  on  the  lower  portion  of  the  tube, 
and  affects  the  uterus  by  sympathy  of  contiguity.  It  is  in  this  way, 
indeed,  that  aloes  has  acquired  its  reputation  as  an  emmenagogue. 


136 


CATHARTICS. 


Cathartics  act  not  only  on  the  bowels  but  on  parts  at  a distance. 
Every  portion  of  the  organism  is  capable  of  being  impressed  by  them. 
They  are  amongst  the  most  generally  useful,  and  applicable  revel- 
lents  that  we  possess  ; and,  when  given  to  such  an  extent  as  to 
cause  hypercatharsis,  they  rapidly  reduce  the  powers  of  the  system, 
— less,  perhaps,  by  the  copious  exhalation  of  the  serous  portions  of 
the  blood,  which  they  cause  from  the  lining  membrane  of  the  intes- 
tines, than  by  the  sympathy  that  exists  between  them  and  the  vital 
organs.  Reference  has  been  made  more  than  once  to  the  destruc- 
tive influence  exerted  on  those  organs  by  irritation — often  unmarked 
by  prominent  symptoms  — in  the  intestinal  tube.  It  is  by  their 
mixed  depletive  and  revulsive  action  that  they  become  useful  sorbe- 
facients  in  hydropic  affections,  and  cases  of  rapid  disappearance  of 
dropsical  effusions  under  their  operation  are  often  witnessed. 

Cathartics  differ  greatly  from  each  other  in  their  mode  of  operating. 
Some  gripe  much  ; others  not  at  all.  Some  operate  many  times, 
others  rarely  more  than  once  ; although  much,  in  this  respect,  de- 
pends upon  the  individual.  Pharmacologists  have  generally  divided 
them,  — according  to  the  intensity  of  their  operation,  — into  laxatives^ 
purgatives^  and  drastics^  under  which  all  the  articles  may  be  arranged. 
To  these  may  be  appended  another  division  — that  of  enemata.  The 
ancient  humorists,  who  considered,  that  most  diseases  were  produced 
by  the  predominance  of  some  particular  humour,  which  needed 
evacuation,  and  that  particular  cathartics  were  eminently  endowed 
with  the  power  of  fulfilling  these  objects,  divided  them  into  hydra- 
gogues^  phlegmagogues^  cholagogues^  and  pantagogues  or  panchyma- 
gogues,  according  as  their  operation  was  exerted  more  especially 
upon  the  watery  portions  of  the  blood,  on  phlegm,  on  bile,  or  on  the 
whole  of  the  secretions  from  the  tube  collectively. 

The  division  of  cathartics  into  laxatives  and  purgatives  is  con- 
venient, and  not  inappropriate.  Laxatives  gently  stimulate  the  mu- 
cous coat  of  the  intestines,  and  augment  the  peristole  but  little  : 
hence^  they  are  well  adapted  for  cases  in  which  the  sole  indication 
is  to  unload  the  bowels  of  their  contents.  Some  of  them  produce 
their  effects  entirely  in  a mechanical  manner.  Corn  bread,  for  ex- 
ample, proves  laxative,  in  consequence  of  the  mechanical  attrition  of 
the  particles  of  husk  left  mixed  with  it  on  the  mucous  membrane. 
In  the  same  manner,  bread,  made  of  unbolted  flour,  is  laxative,  and 
becomes  proper,  in  the  way  of  diet,  when  there  is  torpor  of  the  diges- 
tive function  ; hence  it  has  attained  the  name  dyspeptic  bread.’’^ 
Other  laxatives,  again,  are  special  local  stimulants,  or  affect  the  mu- 
cous membrane  by  their  medicinal  properties,  — as  sulphur,  mag- 
nesia, &c.  These,  when  given  in  a much  larger  dose  than  usual, 
may  still  be  but  laxative.  They  do  not  induce  full  catharsis  ; and 
are,  therefore,  separable,  with  pn^priety,  from  the  division  of  purga- 
tives, many  of  which  cannot,  in  the  most  minute  dose,  be  made  to 
act  as  laxatives. 

Purgatives  produce  their  effects  like  laxatives,  but  their  operation 
is  more  powerful.  They  excite  a copious  exhalation  from  the  mu- 


GENERAL  EFFECTS. 


137 


cous  lining  of  the  intestines,  and  augment  the  peristaltic  action  to  a 
greater  degree.  It  is  in  consequence  of  the  evacuation  of  watery 
matters,  produced  by  the  operation  of  purgatives,  that  they  are  used 
as  depletives  in  febrile,  and  inflammatory  affections  ; and,  from  the 
excitation  they  occasion  in  the  abdominal  nerves,  they  are  energetic 
revellents.  This  excitation  is  often  shown  in  the  tormina  and  irrita- 
tion that  precede  and  accompany  their  operation. 

The  more  violent  purgatives  have  been  termed  drastics.  They 
produce  a greater  degree  of  irritation  in  the  lining  membrane  of  the 
intestines,  and  occasionally  act  upon  the  nerves  of  the  stomach  so  as 
to  induce  nausea,  and  even  vomiting.  They  belong  generally  to  the 
resinous  or  resino-extractive  substances,  and  one  reason,  why  they 
excite  such  violent  tormina,  appears  to  be,  that  they  are  sparingly 
soluble,  and  adhere  to  the  mucous  coat,  from  which  they  are  tardily 
detached.  This  view  is  corroborated  by  the  circumstance,  that  if 
we  add  any  substance  to  them,  which  aids  their  solubility,  the  grip- 
ing may  generally  be  prevented,  or  considerably  mitigated. 

After  all,  however,  the  division  of  cathartics  into  laxatives  and 
purgatives,  although  generally  convenient,  and  not  inappropriate,  is 
not  always  so.  Much  depends  upon  the  individual,  and  hence  a laxa- 
tive may  purge  drastically,  whilst  a drastic  may  scarcely  purge  at 
all.  Still,  these  are  exceptions. 

Cathartics  usually  produce  their  full  effect  without  being  absorbed; 
they  are  altogether  local  stimulants  to  the  mucous  membrane  of  the 
intestines,  and  through  it  to  the  muscular  coat.  Yet,  they  can  act 
by  the  way  of  the  circulation,  and  the  fact  is  another  instance  of  the 
singular  preference,  exerted  by  medicinal  agents  for  certain  parts  of 
the  organism,  rather  than  for  others.  When  a respectable  physician, 
Dr.  Hale,  of  Boston,  injected  castor  oil  into  his  veins,  he  speedily 
felt  an  oily  taste  in  his  mouth,  which  continued  for  a length  of  time, 
and  the  medicine  acted  powerfully  as  a cathartic.  Croton  oil,  when 
placed  on  the  tongue  of  an  apoplectic,  in  whom  deglutition  is  im- 
practicable, produces  its  ordinary  cathartic  operation.  Rhubarb 
exerts  the  same  agency  when  applied  to  the  skin  ; and  the  milk  of  a 
wet-nurse,  who  has  taken  infusion  of  senna,  rhubarb  or  other  cathar- 
tics, may  act  upon  the  intestinal  canal  of  the  child. 

As  a general  rule,  the  action  of  cathartics  is  in  a direct  ratio  with 
the  dose  within  certain  limits.  Some,  however,  are  so  potent,  that 
it  is  almost  impracticable  to  reduce  them  to  the  point  at  which  they 
are  simple  laxatives.  Elaterium  is  one  of  these.  On  the  other  hand, 
there  are  agents,  whose  operation  is  altogether  so  gentle,  that  if  given 
to  any  amount,  they  will  not  be  drastics.  Such  is  the  case  with 
manna,  magnesia,  sugar,  and  olive  oil.  Their  operation  is  always 
that  of  gentle  cathartics  or  laxatives.  There  are  substances,  again, 
of  this  class,  whose  operation  in  a full  dose  is  more  violent  than 
that  which  is  considered  to  characterise  the  action  of  laxatives,  and 
which,  when  given  in  a much  larger  quantity,  exert  no  more  energy. 
Such  is  the  general  fact  with  calomel,  castor  oil,  and  rhubarb,  'i  he 
12^ 


138 


CATHARTICS. 


effect  of  these  cathartics  is  commonly,  indeed,  but  little  understood, 
or,  if  understood,  but  little  attended  to.  A tea-spoonful  or  two  of 
castor  oil  is  often  sufficient  to  evacuate  the  bowels,  not  only  in  health, 
but  in  chronic  febrile  and  other  affections, — where  the  object  is 
simpiy  to  produce  such  evacuation.  Exceptions,  indeed,  occur  to 
this,  but  the  rule  is  not  the  less  general ; and  it  is  important  to  bear 
it  in  mind,  inasmuch  as  the  stomach  is  often  extremely  irritable,  and 
but  little  adapted,  in  those  affections,  for  the  reception  of  a consider- 
able quantity  of  indigestible  oleaginous  matter.  Given  in  these 
small  doses,  it  is  one  of  the  best  cathartics  we  possess  for  keeping  the 
alimentary  canal  clear,  when  there  is  irritation  of  the  gastro-enteric 
mucous  membrane,  as  in  gastric  and  other  fevers.  It  has  been  main- 
tained, indeed,  by  Rasori  and  others,  that  the  action  of  all  cathartics 
increases  in  a direct  ratio  with  the  dose  within  certain  limits  only, 
and  that  beyond  these,  the  opposite  is  the  fact, — the  evacuant  power 
being,  in  other  words,  directly  as  the  dose  up  to  a certain  point,  and 
inversely  as  the  dose  beyond  that  point ; that  in  the  latter  case  they 
may  act  as  sedatives  without  producing  any  cathartic  effect  what- 
ever; and  that,  consequently,  most  purgative  medicines  maybe  con- 
sidered not  only  as  simple  evacuants,  but  as  antiphlogistics  or  se- 
datives. To  this  subject,  however,  reference  will  have  to  be  made 
under  the  individual  articles  of  the  class,  and  especially  under  Calo- 
mel, where  the  difference  of  action  according  to  the  dose  is  more 
strongly  marked  perhaps  than  in  the  case  of  any  other  cathartic. 

Substances,  when  largely  divided,  so  that  fresh  and  fresh  portions 
come  into  contact  with  the  lining  membrane  of  the  digestive  tube, 
generally  act  with  more  efficiency,  than  when  they  are  given  in  such 
form,  that  the  cathartic  touches  in  bulk  the  surface  on  which  it  has 
to  operate.  Thus,  an  ounce  of  the  sulphate  of  magnesia,  dissolved 
in  half  a pint  of  water,  and  taken  by  tea-spoonfuls,  at  short  intervals, 
will  induce  a greater  action  than  if  the  whole  solution  were  swallowed 
at  once.  This  fact  is  elucidated  by  a case,  which  the  late  Dr.  James 
Gregory,  of  Edinburgh,  was  in  the  habit  of  relating  in  his  lectures. 
A boy  was  directed  to  take  an  ounce  of  Epsom  salts,  but,  having  a 
strong  objection  to  the  taste  of  the  cathartic,  he  resolved  , to  form  it 
into  pills  with  crumb  of  bread.  On  making  the  pills  of  an  appro- 
priate size,  he  found  they  amounted  to  three  hundred  and  sixty,  a 
number  corresponding  so  nearly  with  that  of  the  days  of  the  year, 
that  he  determined  to  make  it  correspond  entirely.  Accordingly,  he 
divided  them  into  three  hundred  and  sixty-five  portions,  and  took 
them  one  after  the  other.  The  effect  was  extraordinary.  The  most 
violent  hypercatharsis  was  induced  so  as  to  endanger  his  life.  This 
was  owing  probably  to  the  gradual  and  successive  breaking  down  of 
the  pills  in  the  stomach,  so  that  particle  after  particle  came  in  con- 
tact with  the  mucous  membrane,  and  exerted  its  specific  effect. 

We  can  thus  understand,  that  a saline  cathartic,  dissolved  in  a 
large  quantity  of  water,  may  act  more  powerfully  than  if  the  quantity 
of  the  solvent  were  less.  In  many  of  the  saline  mineral  waters. 


GENERAL  EFFECTS. 


139 


which  are  employed  as  cathartics,  the  quantity  of  saline  ingredients 
is  extremely  small.  A pint  of  Seltzer  water  is  found  to  con- 
tain but  five  grains  of  carbonate  of  magnesia  and  seventeen  of  chlo- 
ride of  sodium.  The  same  measure  of  Spa  water  contains  nine  and 
a half  grains  of  carbonate  of  magnesia,  and  one  quarter  of  a grain 
of  chloride  of  sodium.  The  Aix-la-Chapelle  water  has  five  grains  of 
chloride  of  sodium  to  the  pint  ; the  Balston,  five  grains  of  carbonate 
of  magnesia,  and  eighteen  of  chloride  of  sodium  ; the  Bedford,  one 
and  a half  grain  of  chloride  of  sodium,  and  ten  grains  of  sulphate  of 
magnesia  ; and  the  Congress  spring,  at  Saratoga,  twelve  grains  of 
carbonate  of  magnesia,  and  forty-eight  gi'ains  of  chloride  of  sodium. 

Many  of  the  resinous  purgatives  excite  much  griping  during  their 
action,  — apparently  — as  observed  above  — by  adhering  to  the 
mucous  lining,  and  acting  as  violent  irritants  ; hence  corrigents  are 
required  to  remove  the  disagreeable  accompaniments  of  their  ordinary 
operation.  These  may  consist,  — either  of  substances,  which  add  to 
their  solubility  ; — of  agents,  which,  by  augmenting  the  peristole  of 
the  canal,  hurry  on  the  cathartic,  so  that  it  does  not  remain,  for  any 
length  of  time,  in  contact  with  any  one  portion  of  the  mucous  mem- 
brane ; — or  of  such  as  shield  the  intestinal  canal  against  its  irritating 
influence. 

As  a general  rule,  the  soluble  cathartics  act  more  speedily  than 
the  others  ; yet,  the  cathartic  oils  are  exceptions  to  this,  for  they  are 
scarcely,  if  at  all,  soluble,  — undergoing  little  or  no  change  in  the 
stomach.  Castor  oil  becomes  mixed  with  the  various  secretions  and 
substances  in  the  alimentary  canal,  and  is  divided  into  small  filaments, 
so  as  occasionally  to  deceive  the  practitioner.  Some  years  ago,  J. 
P.  Frank  was  requested  to  see  a prince,  who  had  been  attacked 
with  epilepsy.  His  physician,  a respectable  old  practitioner,  assured 
Frank,  that  he  could  at  pleasure  make  his  patient  void  thousands  of 
filiform  worms.  As  he  was  neither  able  to  define  the  genus,  nor 
species  of  these  worms,  the  quantity  of  which,  from  his  account,  was 
prodigious,  Frank  requested  to  be  a witness  of  the  phenomenon. 
The  physician  administered  a dose  of  castor  oil,  which  produced 
several  evacuations,  in  wfliich  were  thousands  of  whitish  filaments 
resembling  small  eels ; but  on  an  attentive  examination,  these  sup- 
posed worms  were  found  to  consist  entirely  of  castor  oil,  divided  in  the 
manner  above  mentioned. 

Owing  to  the  fact,  that  — as  a general  rule — soluble  cathartics 
act  sooner  than  those  that  are  less  so,  we  can  understood,  that  mix- 
tures may  operate  more  speedily  than  pills  ; that  saline  cathartics  may 
act  more  freely  if  we  allow  liquids  to  be  taken  during  their  opera- 
tion, and  that  resinous  cathartics  may  be  longer  in  operating  than  the 
saline.  It  has  been  attempted  — but  not  with  complete  success  — 
to  show,  that  difference  of  solubility  may  account  for  certain  purga- 
tives acting  more  upon  one  part  of  the  intestinal  canal  than  upon 
another. 

When  demulcents  are  given  along  with  acrid  purgatives,  they 
moderate  the  violence  of  their  action,  by  shielding  the  mucous,  sur- 


140 


CATHARTICS. 


face,  so  as  to  diminish  the  amount  of  local  stimulation.  In  the  same 
way,  narcotics  lessen  the  impressibility  of  the  nervous  system,  and 
thereby  diminish  the  operation  of  cathartics,  but  if  much  spasm  exist 
in  the  intestinal  canal,  they  may  aid  the  operation.  Suppose,  for 
example,  a state  of  constipation,  accompanied  with  violent  colic,  but 
without  enteric  inflammation  ; the  combination  of  a full  dose  of  an 
opiate  with  a cathartic  will  allay  the  spasm,  and  induce  catharsis. 
Indeed,  where  enteric  inflammation  actually  exists  — especially  if 
copious  blood-letting  have  been  premised  — such  a union  of  seda- 
tive and  cathartic  is  often  succeeded  by  the  most  beneficial  results. 
The  different  varieties  of  colic,  by  many  intelligent  practitioners,  are 
treated  almost  wholly  by  a combination  of  calomel  and  opium. 

If  the  desire  be  simply  to  evacuate  the  bowels,  without  heeding 
the  revulsive  effect,  which  cathartics  are  capable  of  inducing,  the 
rapid  purgatives  and  forms  of  administration  are  to  be  chosen  ; — 
such  as  castor  oil,  and  the  various  saline  substances  ; but,  where 
habitual  constipation  exists,  it  is  not  always  advisable  to  administer 
these  agents,  in  such  doses  as  to  act  violently.  A cathartic  removes 
the  contents  of  the  canal,  but  it  does  not  obviate  the  pathological 
condition,  which  gives  rise  to  the  constipation.  On  the  contrary,  in 
accordance  with  the  laws  of  compensation,  which  prevail  so  exten- 
sively in  the  animal  economy,  it  is  found,  that  the  tendency  to  con- 
stipation is  augmented  after  its  operation,  — diminished  action  of  the 
exhalants  of  the  mucous  membrane,  and  of  the  muscular  coat  succeed- 
ing to  the  exaltation  of  the  vital  manifestations,  produced  by  the  ope- 
ration of  the  cathartic  ; hence,  if  active  cathartics  be  had  recourse  to, 
in  habits  disposed  to  constipation,  whenever  this  state  exists,  the  per- 
son, in  time,  demands  so  imperiously  the  stimulation  they  excite,  that 
he  is  unable  to  have  an  evacuation  without  them.  This  result  is  more 
liable  to  supervene  after  the  action  of  certain  purgatives  than  of  others. 
Castor  oil,  and  croton  oil  are  more  exempt  from  it  than  other  cathar- 
tics, whilst  rhubarb  is  generally  esteemed  more  obnoxious  to  the  re- 
mark than  any  of  the  class. 

The  best  mode  of  obviating  this  tendency  to  constipation  is  to 
avoid  the  exhibition  of  cathartics,  that  powerfully  excite  the  organs 
directly  and  indirectly  concerned  in  defecation,  and  to  trust  altoge- 
ther to  the  employment  of  laxatives,  and  an  appropriate  regimen.  The 
best  laxatives,  for  such  purpose,  are  those  that  affect  the  whole  extent 
of  the  canal,  and  possess  the  property  of  developing  its  impressibility. 
Such,  it  has  been  seen,  is  the  operation  of  saline  cathartics.  A good 
preparation  of  this  kind  is  a mixture,  formed  by  pouring  a quart  of 
boiling  water  on  an  ounce  of  sulphate  of  magnesia,  and  one  drachm 
of  bitartrate  of  potassa,  and  directing  the  patient  to  take  a wine- 
glassful  of  the  solution  every  night  and  morning,  until  the  bowels 
are  made  to  respond  properly.  The  bitartrate  of  potassa  is  laxative, 
and  its  acid  character  masks  the  disagreeable  taste  of  the  sulj)hate  of 
magnesia  : the  combination  rarely  fails  to  restore  the  intestinal  func- 
tions to  their  due  condition  ; but  it  is  occasionally  necessary  to  per- 
severe in  the  use  of  the  remedy  for  some  weeks  before  the  full  benefi- 


MODUS  OPERANDI. 


141 


cial  results  are  obtained.  The  author  had  a marked  case  of  the  good 
effects  of  this  agent  on  a gentleman,  who  was  unable  to  have  an 
ev^acuation  without  the  use  of  rhubarb,  of  which  he  was  compelled 
to  chew  a considerable  quantity  daily.  The  habit  was  broken  in 
upon,  and  the  bowels  restored  to  their  proper  action,  by  the  use  of 
the  saline  solution,  but  no  decided  benefit  was  derived,  until  it  had 
been  persevered  in  for  some  time. 

It  is  easy  to  conceive,  that  cathartics,  which  simply  evacuate  the 
contents  of  the  bowels,  may  be  more  demanded  in  warm  climates 
and  seasons  than  in  cold,  in  consequence  of  the  erethism  of  the 
mucous  membrane  of  the  alimentary  tube,  which  is  developed  during 
great  atmospheric  heat;  yet,  owing  to  this  very  erethism,  as  well  as 
to  the  greater  degree  of  sensibility  of  the  nervous  system,  generally 
induced  by  the  same  atmospheric  condition,  drastic  cathartics  may 
have  to  be  used  with  more  caution. 

The  abuse  of  purgatives,  like  that  of  emetics,  occasions  great  ex- 
altation of  the  sensibility  of  the  digestive  tube.  Broussais  observes, 
in  the  commentary  to  his  155th  proposition,  that  he  had  frequent 
opportunities  for  witnessing  this  effect  in  persons,  who  had  taken  the 
purgative  of  Le  Roy,  in  the  manner  directed  by  that  empiric,  — that 
is,  for  several  days  in  succession.  So  miich  irritability  of  the  digestive 
apparatus  was  caused,  that  it  was  impossible  to  restore  the  equilibrium 
of  action.  “In  them,  digestion,  defecation,  and  even  the  simple 
passage  of  matters  into  the  small  intestine  are  painful ; many  very 
uneasy  and  singular  sensations  accompany  the  slightest  efforts  of  the 
muscles  of  the  stomach  and  intestines,  and  are  felt  not  only  in  the 
abdomen,  but  in  every  part  in  which  the  cerebral  nerves  predominate. 
A most  unpleasant  buzzing  in  the  ears  is  the  first  consequence  of 
these  imprudent  medications;  to  this,  various  pains  in  the  head  are 
soon  added,  with  weight  and  fulness  of  the  eyelids;  tenderness  of 
the  limbs,  joints,  and  periosteum,  and  of  a portion  of  the  skin,  with 
often  an  inexpressible  uneasiness,  the  seat  of  which  cannot  be  assigned 
to  any  particular  part.  Almost  every  kind  of  motion  becomes  pain- 
ful at  certain  periods  of  digestion;  but  as  these  pains  are  not  always 
referred  to  the  exact  portion  of  the  stomach  or  bowels  with  which  the 
food  is  in  contact,  as  most  commonly  the  ingestion  of  food  is  followed 
by  a feeling  of  health,  which  causes  a momentary  oblivion  of  all 
suffering,  the  patients  accustom  themselves  to  associate  the  idea  of 
improvement  with  that  of  agreeable  food  or  drink,  and  make  the 
sum  of  their  evils  an  entity  (disease)  for  which  tonics  are  the  true 
remedies.” 

Although  it  may  happen,  that  all  these  signs  of  mischief  are  occa- 
sionally produced  by  the  abuse  of  cathartics,  they  rarely  perhaps  pre- 
sent themselves,  in  conjunction,  in  the  same  individual.  At  the 
present  day,  indeed,  such  abuse  is  by  no  means  as  common  as  it 
was  half  a century  ago;  the  impropriety  of  keeping  up  perpetual 
irritation  in  the  lining  membrane  of  the  intestines,  in  diseases,  often 
themselves  arising  from  irritation  in  this  very  membrane,  having 
become  appreciated.  It  need  hardly  be  added,  that  whenever  such 


142 


CATHARTICS. 


irritation  or  active  inflammation  is  shown  to  exist,  the  operation  of 
drastic  cathartics,  or  of  ordinary  purgatives,  is  contra-indicated, 
although  it  may  still  be  important  to  preserve  the  tube  free  from 
morbid  secretions  — which  cannot  fail  to  be  thrown  out  in  such  a 
state  of  the  membrane  — as  well  as  from  extraneous  matters  taken  as 
aliment,  which,  under  febrile  heat,  might  be  likely  to  undergo  mor- 
bific changes.  The  bad  effects,  resulting  from  the  administration  of 
active  cathartics,  in  cases  of  fever  of  the  adynamic  kind  especially, 
are  yet  too  frequently  witnessed. 

During  gestation,  as  well  as  during  menstruation,  violent  cathartics 
must  be  prescribed  with  caution ; and  those,  whose  action  is  exerted 
by  preference  on  the  lower  part  of  the  intestinal  canal,  should  — as 
a general  rule  — be  avoided.  For  this  reason  purgatives  of  the 
aloetic  kind  are  not  given,  unless  their  operation  is  tempered  by  the 
addition  of  some  substance,  as  soap,  which,  by  adding  to  their  solu- 
bility, diffuses  their  action  over  a larger  surface  of  the  alimentary 
canal ; or,  by  the  addition  of  a narcotic,  as  hyoscyamus,  which 
renders  their  operation  less  irritating.  Many  of  the  abortives,  em- 
ployed with  a criminal  intent,  belong  to  the  class  of  cathartics,  — 
their  primary  operation  being  exerted  on  the  intestinal  canal,  and  the 
uterus  becoming  affected  by  contiguous  sympathy. 

A selection  of  cathartics  may  be  made,  to  a certain  extent,  to  suit 
the  age  of  the  individual.  In  very  young  infants,  the  milder  ca- 
thartics are  employed,  — as  castor  oil ; magnesia ; or  rhubarb,  — com- 
bined, or  not,  with  magnesia.  Generally,  during  early  childhood, 
there  is  a great  predominance  of  acidity,  so  that  absorbent  laxatives 
are  especially  indicated  ; hence  it  is,  that  magnesia  is  in  such  common 
use.  Calomel  is  also  much  given  during  the  first  periods  of  life, 
owing  to  the  facility  with  which  it  can  be  administered.  In  old  age, 
the  warmer  resinous  cathartics  are  usually  employed,  and  these  are 
generally  given  in  the  form  of  pill. 

In  referring  to  the  influence  of  the  moral  over  the  ■physique^  it  was 
remarked,  that,  under  particular  emotions,  some  of  the  excretory 
functions  are  acted  upon,  and,  amongst  these,  those  concerned  in 
defecation.  Anxious  dread,  or  excessive  fear  has  this  effect  in  a 
marked  manner;  and  it  has  been  probably  experienced  by  every  one 
under  such  circumstances.  Certain  emotions  may,  therefore,  be 
looked  upon  as  mental  cathartics^  although,  as  such,  not  capable  of 
being  employed  in  the  treatment  of  disease. 

In  the  administration  of  cathartics,  some  choice  as  to  time  can 
occasionally  be  indulged.  For  example,  if  the  pilular  form  be  chosen, 
and  substances  difficult  of  solution  be  selected,  they  may  be  taken 
at  bedtime.  Accordingly,  pills  of  the  mild  chloride  of  mercury  — 
to  be  followed  the  next  morning  by  a saline  or  other  soluble  cathartic 
— are  directed  to  be  taken  at  the  time  of  retiring  to  rest.  On  the 
other  hand,  saline  aperients,  castor  oil,  &c.,  are  generally  given  in 
the  morning,  their  operation  being  more  speedy,  and  therefore  more 
likely  to  disturb  the  patient,  if  administered  at  night.  Very  early  in 
the  morning,  when  the  stomach  is  entirely  empty,  a small  dose  of  a 


GENERAL  EFFECTS. 


143 


cathartic  often  operates  as  speedily,  and  effectually,  as  a much  larger 
taken  after  breakfast.  Of  course  when  the  administration  of  cathartics 
is  imperiously  demanded,  no  opportunity  is  left  for  choice  of  time. 

During  the  action  of  cathartics,  the  dermoid  system  is  extremely 
impressible  ; and  if  the  patient  be  exposed  to  the  partial  and  irregular 
application  of  cold,  derangement  of  capillary  action  is  apt  to  be  in- 
duced, and  if  there  be  any  tissue  or  organ,  particularly  liable  at  the 
time  to  take  on  diseased  action,  it  will  be  apt  to  do  so.  Should  the 
cathartic  operate  more  frequently,  or  more  powerfully,  than  is  de- 
sirable ; a few  drops  of  laudanum  may  be  given  in  a glass  of  water: 
or  a starch  and  laudanum  enema  may  be  administered.  The  latter, 
however,  is  rarely  necessary. 

enem'ata. 

Cathartics  may,  likewise,  be  exhibited  to  act  on  the  lower  part  o-f 
the  intestinal  tube  by  direct  application.  In  this  form,  they  are 
termed  cathartic  glysters^  enemata^  or  lavemens.  When  thrown  in 
contact  with  the  lining  membrane  of  the  rectum  they  irritate  it ; and, 
by  sympathy  of  continuity,  their  influence  is  extended  to  the  upper 
portion  of  the  tube.  Hence,  they  may  be  administered  with  advan- 
tage, when  cathartics  cannot  be  easily  given  by  the  mouth,  as  where 
deglutition  is  impracticable.  Accordingly,  in  apoplexy,  trismus,  &c., 
this  is  a mode  of  exhibiting  purgative  and  other  remedies  often  had 
recourse  to.  It  is  obvious,  too,  that  glysters  may  be  given  with  ad- 
vantage to  aid  the  operation  of  cathartics  ; and,  in  cases  of  extreme 
debility,  in  which  apprehension  is  entertained,  that  cathartics,  ad- 
ministered in  the  ordinary  mode,  may  act  too  powerfully,  glysters  can 
be  advantageously  substituted.  They  are  most  valuable  agents,  and. 
until  of  late,  have  been  too  little  employed  in  this  country,  as  well  as 
in  Great  Britain  ; but,  on  the  continent  of  Europe,  they  form  a part 
of  the  boudoir  of  every  female,  and  are  regarded  indispensable  to 
cleanliness  and  to  health.  In  the  Malade  Iniaginaire  of  Moliere, 
Argan  enters  on  the  stage,  reading  his  apothecary’s  bill, — in  which 
the  clyster  and  its  adaptation  occur  over  and  over  again, — without 
any  feeling  of  outraged  delicacy  on  the  part  of  the  auditors  ; whilst 
with  us  the  slightest  allusion  to  the  operation  or  the  instrument  cannot 
be  mentioned  to  ears  polite. 

Even  cold  water,  thrown  into  the  rectum,  excites  the  peristole  of 
the  intestines,  and  produces  a salutary  effect  in  inflammation  of  the 
lining  membrane;  — the  cooling  influence  being  propagated  upwards, 
by  virtue  of  the  extensive  sympathy  that  exists  between  every  part  of 
the  capillary  surface.  In  the  same  manner,  warmth  can  be  applied 
so  as  not  only  to  act  as  a fomentation  to  the  parts  with  which  the 
material  of  the  glyster  comes  in  contact,  but  to  have  the  soothing 
effect  extended  to  parts  above  ; and,  by  means  of  contiguous  sym- 
pathy, to  organs  seated  in  the  vicinity  of  the  lower  portions  of  the 
tube.  With  both  these  views  enemata  are  administered,  but  they 


144 


CATHARTICS. 


are  chiefly  used  for  the  purpose  of  stimulating  the  canal,  so  as  to 
occasion  the  evacuation  of  its  contents.  For  this  purpose,  warm 
water,  soap  and  water,  salt  and  water,  molasses  and  water,  or  gruel 
with  the  addition  of  salt  or  castor  oil,  are  generally  the  selected  vehi- 
cles ; and  if  the  desire  be  to  excite  considerable  revulsion  in  the  rec- 
tum, oil  of  turpentine  may  be  added,  either  formed  into  an  emulsion 
with  the  yolk  of  egg,  or  simply  mixed  with  the  gruel  or  other  con- 
stituents of  the  enema.  At  times,  where  the  idea  exists,  that  consti- 
pation is  the  effect  of  spasm  in  some  part  of  the  canal,  the  tobacco 
glyster  is  administered.  This  may  be  given  either  in  the  way  of 
infusion  or  of  smoke,  which  latter  may  be  thrown  up  through  an  or- 
dinary tobacco-pipe  ; — the  tobacco  being  placed  in  the  bulb.  It  is 
then  ignited,  and  the  bulb  being  put  into  the  mouth,  the  smoke  can 
be  readily  forced  into  the  intestinal  canal,  by  blowing  through  the 
tube.  The  exhibition  of  tobacco,  in  either  mode,  is  attended,  how- 
ever, with  danger,  and  therefore  it  ought  only  to  be  had  recourse  to 
with  great  caution.  Cases,  as  elsewhere  remarked,  are  on  record  of 
fatal  results  from  an  infusion  of  the  strength  directed  in  the  pharma- 
copoeias. 

When  glysters  are  administered  by  the  ordinary  bag  and  pipe,  they 
rarely  go  farther  than  the  rectum,  and  may  therefore  fail  altogether  in 
their  operation.  The  syringe,  employed  of  recent  date,  is  capable  of 
propelling  the  enema  farther ; but,  at  times,  it  also  fails,  especially 
where  there  is  any  obstruction  at  the  termination  of  the  sigmoid 
flexure  of  the  colon,  as  is  not  unfrequently  the  case.  Dr.  O’Beirne 
has  very  properly  directed  attention  to  this  point  in  the  pathology  of 
defecation,  and  has  advised,  that  an  elastic  gum  tube,  like  the  ordi- 
nary stomach  tube,  should  be  gently  insinuated  through  the  narrow 
portion  at  the  sigmoid  flexure,  until  it  has  entered  the  colon  ; in  this 
way,  liquid  faeces  or  flatus  are  occasionally  brought  away  after  every 
ordinary  remedy  has  failed  ; and  by  attaching  the  external  extremity 
of  the  tube  to  the  stomach  pump,  an  enema  may  be  projected  into 
the  colon,  and  prove  effectual,  when  the  ordinary  enemata,  as  usually 
exhibited,  may  have  been  administered  in  vain. 

Some  years  before  the  appearance  of  Dr.  O’Beirne’s  observations, 
the  author  had  an  interesting  case  of  obstruction  of  the  bowels,  in  an 
aged  individual,  who,  for  almost  the  whole  period  of  his  existence, 
had  held  an  honourable  situation  in  his  country’s  service.  In  this 
case,  the  colon  appeared  to  be  much  distended  by  flatus.  Injection 
after  injection  was  thrown  up  by  the  only  means  at  hand  — the  bag 
and  pipe  — but  no  relief  was  obtained.  The  symptoms  became 
more  and  more  urgent.  Under  these  circumstances,  the  idea  oc- 
curred, that  if  a hollow  instrument  could  be  passed  up  until  it  reached 
the  part  of  the  colon  above  the  seat  of  the  constriction,  relief  might 
be  obtained.  Accordingly,  a large  sized  elastic-gum  male  catheter 
was  passed,  with  some  difficulty,  through  the  sigmoid  flexure,  and  as 
soon  as  its  extremity  attained  the  colon,  a considerable  discharge  of 
fetid  gas  took  place,  and  relief  was  instantaneous.  This  agency 


SUPPOSITORIES. 


145 


would  probably  be  completely  successful  in  affording  relief,  in  those 
cases  in  which  it  has  been  recently  advised  to  force  air  into  the  in- 
testines for  the  removal  of  colic  occasioned  by  the  presence  of  air  in 
the  intestines  ; — a plan  of  treatment,  by  the  way,  which  is  minutely 
described  by  Swift,  and  the  invention  assigned  to  a medical  philo- 
sopher of  the  Academy  of  Lagado. 

The  quantity  of  fluid  to  be  administered  in  the  way  of  enema 
must  vary  according  to  age,  and  other  circumstances.  For  an  in- 
fant, a few  ounces  may  be  sufficient ; for  an  adult,  from  a pint  to  a 
quart ; but  if  the  desire  be  to  wash  out  the  colon,  a considerable 
quantity  may  be  necessary.  In  all  cases,  when  given  to  produce  a 
cathartic  operation,  the  fluid  ought  not  to  be  sent  in  too  rapidly,  as 
it  is  apt  to  excite  the  rectum  to  action,  so  as  to  occasion  its  imme- 
diate return,  bringing  along  with  it  only  the  contents  of  that  gut. 
The  enema  ought  to  stay  long  enough  to  excite,  by  sympathy,  the 
whole  tract  of  the  large  intestines  at  least ; and,  therefore,  if  it 
comes  away  in  a few  minutes  — and  especially  if  the  discharge  has 
but  little  fsecal  matter  mixed  with  it  — it  ought  to  be  repeated. 

SUPPOSITORIES. 

It  has  been  already  remarked,  that  glysters  are  excellent  revel- 
lents,  when  composed  of  materials  possessed  of  excitant  properties. 
The  same  may  be  said  of  suppositories^  which  are  special  excitants, 
or  ordinary  excitants,  according  to  the  ingredients  of  which  they 
are  composed.  In  early  infancy,  they  are  often  employed  to  open 
the  bowels,  and  are  usually  composed  of  turpentine  soap,  — a small 
conical  piece,  moistened,  being  forced  up  into  the  rectum,  and  left 
there,  when  it  generally  produces  a free  evacuation  of  the  lower 
part  of  the  canal.  At  times,  the  soap  is  smeared  over  with  castor 
oil ; at  others,  with  turpentine,  to  add  to  the  cathartic  effect.  In  this 
way,  as  well  as  by  glyster,  any  medicinal  agent  may  be  brought  to 
affect  the  rectum  ; and  accordingly,  cathartics,  opiates,  &c.,  are  often 
so  administered. 

It  has  been  proposed  to  introduce  a kind  of  galvanic  suppository, 
made  of  two  metals  — zinc  and  copper  — into  the  rectum,  for  the 
removal  of  constipation,  and  this  has  been  attended,  in  some  cases, 
with  good  effects ; not,  probably,  in  consequence  of  any  specific  ex- 
citation of  the  nerves  of  the  rectum  by  galvanism,  but  by  its  acting 
as  an  ordinary  excitant  to  the  nerves  of  the  mucous  membrane. 

Another  mode  of  employing  the  galvanic  excitation  is  by  forming 
a connection  between  two  different  metals  ; one  being  introduced 
into  the  mouth,  the  other  into  the  rectum  ; but  this  apparatus  is  not 
possessed  of  more  energy  than  the  first,  and  both  are  perhaps  largely 
indebted  for  their  action  to  the  local  excitation  which  their  presence 
in  the  rectum  engenders.  The  public  and  even  the  profession  have 
been  amused  by  various  instruments,  invented  for  the  application  of 
galvanism  to  different  parts  of  the  body  ; and  if  their  efficacy  on  the 
VOL.  I.  — 13 


146 


CATHARTICS 


frame  have  not  been  well  marked,  they  have  not  failed  to  minister 
to  the  pockets  of  their  inventors. 

Dr.  A.  T.  Thomson  remarks,  that  the  peristaltic  action  of  the  in- 
testines may  be  increased  by  various  external  means;  and,  of  these, 
he  instances  the  electrical  aura  as  highly  useful  in  simple  torpor  of 
the  gut and  the  dashing  of  cold  water  on  the  lower  extremities, 
which  has  succeeded  in  procuring  the  immediate  evacuation  of  the 
intestines  ‘‘  in  obstinate  costiveness,  particularly  in  the  case  of  ileus, 
when  all  other  means  have  failed.”  Both  these  agents  produce  their 
effect  less  as  special  excitants,  than  by  modifying  the  nervous  distri- 
bution. We  have  already  seen,  that  there  are  many  nervous  modi- 
fications,— those  through  the  influence  of  the  mind  especially, — 
which  act  upon  the  intestinal  canal,  so  as  to  produce  catharsis. 

Therapeutical  Application  of  Cathartics. 

The  therapeutical  application  of  cathartics  will  now  be  intelligi- 
ble. They  may,  of  course,  be  employed  with  various  objects : — 
either  to  act  as  simple  evacuants,  as  depleting  agents,  or  as  revel- 
lents. 

Fever.  — In  the  disordered  state  of  functions,  constituting  gene- 
ral fever  — whatever  may  be  its  variety  — their  use  is,  throughout 
the  disease,  more  or  less  indicated.  In  the  state  of  erethism  that 
exists  in  every  portion  of  the  dermoid  structure,  morbid  secretions 
are  necessarily  formed,  which,  if  not  removed,  act  as  fomites  and 
induce  irritation  ; yet  although  cathartics  of  a mild  kind  are  needed 
to  keep  the  intestinal  canal  free,  it  is  — as  has  been  before  observ- 
ed — a great  mistake  to  irritate  the  lining  membrane  of  the  intes- 
tines by  drastics,  in  diseased  conditions  in  which  the  absence  of  all 
irritation — mental  as  well  as  corporeal  — ought  to  be  inculcated  ; 
and  this  remark  applies  especially  to  fevers,  which  are  apt  to  be  ac- 
companied by  unusual  irritation  in  the  mucous  membrane  of  the  sto- 
mach, and  small  intestines.  The  plan  to  be  pursued  in  such  cases 
seems  to  be  clearly  indicated,  — to  attack  the  local  inflammation, 
and  the  general  increased  action,  by  bleeding — general  and  local  — 
and  by  the  use  of  refrigerants;  to  keep  the  canal  free  by  cathartics 
of  the  mildest  kind, — as  a tea-spoonful  of  the  oleum  ricini,  repeated 
at  intervals  if  necessary;  — and,  under  this  system,  the  issue  is,  ac- 
cording to  the  author’s  experience,  far  more  fortunate  than  where 
much  irritation  is  kept  up  in  the  intestinal  canal.  Reflection,  in- 
deed, suggests,  at  a glance,  the  impropriety  and  inconsistency  of  any 
irritating  plan  of  medication  in  fever.  We  carefully  employ  seda- 
tive agents  ; recommend  the  most  careful  abstraction  of  light,  and 
sound,  and  the  avoidance  of  all  irritation,  except  that  which  we  offi- 
ciously excite  in  a part  of  the  system,  which,  as  Broussals  has  pro- 
perly maintained,  possesses  intimate  sympathetic  relations  with  every 
other  part  of  the  organism  ; and,  under  this  mode  of  management, 
many  cases  of  continued  and  remittent  fever,  doubtless,  run  their 


IN  FEVER. 


147 


course  to  a fatal  termination,  which,  under  a better  system  of  treat- 
ment, would  have  terminated  in  health.  It  must  be  borne  in  mind, 
that,  in  these  cases,  the  objection  is  not  to  cathartics  in  the  abstract. 
The  employment  of  mild  cathartics  to  keep  the  alimentary  tube  en- 
tirely free  from  all  morbid  secretions  must  be  regarded  as  one  of  the 
most  important  points  in  the  management  of  fevers,  that  are  even 
accompanied  with  an  unusual  degree  of  erethism  of  the  gastro-ente- 
ric  mucous  membrane.  It  is  the  powerfully  irritating  cathartic  — 
that  excites  evacuation  after  evacuation,  and  exhausts  the  patient  by 
irritation  — which  is  so  objectionable.  The  author  is  satisfied,  that 
many  cases  of  continued  and  remittent  fever  have  arrived  at  a happy 
termination  by  the  treatment  above  recommended,  which  might  have 
eventuated  unfortunately,  had  the  irritating  cathartic  agency,  so 
strongly  inculcated  by  several  distinguished  teachers  and  authors, 
within  so  late  a period  as  the  last  fifty  years,  been  adopted.  If  we 
cast  our  eyes  over  the  periodicals  which  are  daily  emanating  from 
the  press,  we  find  that  such  agency  is  beginning  to  be  less  and  less 
invoked,  although  the  attention  of  the  practitioner  is  equally  directed 
to  the  gentle  removal  of  all  offending  matters  from  the  intestinal 
canal.  Laxatives,  or  gentle  cathartics  — in  other  words — have 
taken  the  place  of  the  more  violent,  and  the  improvement  has  been 
signal. 

In  fevers  of  the  synochal  or  inflammatory  kind,  unaccompanied 
by  much  gastro-enteric  irritation,  more  powerful  cathartics  may  be 
employed,  the  object  being  to  use  them  as  depleting  agents,  as 
well  as  for  the  purpose  of  evacuating  offending  matters.  In  such 
cases,  recourse  is  had,  more  commonly,  to  saline  cathartics,  which, 
by  exciting  the  action  of  the  exhalants  of  the  mucous  membrane 
generally,  occasion  the  evacuation  of  a portion  of  the  more  watery 
parts  of  the  blood. 

It  has  been  generally  inculcated,  that  whenever  the  evacuations 
are  fetid  or  ill-conditioned,  it  is  necessary  to  repeat  the  cathartic, 
until  their  natural  healthy  character  is  restored  ; but  if  the  alimentary 
canal  be  kept  clear  from  the  commencement  of  the  disease,  it  can 
rarely  happen,  that  this  fetid  character  will  be  marked,  or  to  such  an 
extent  as  to  demand  much  attention.  Besides,  it  must  be  recol- 
lected, that  they  may  be  rendered  ill-conditioned  by  the  employment 
of  these  very  agents.  When  the  mild  chloride  of  mercury,  for  ex- 
ample, is  exhibited  for  some  time,  it  modifies  the  secretion  from  the 
different  grandular  and  follicular  organs,  and  gives  occasion,  as  before 
mentioned,  to  green  or  dark  coloured  evacuations — calomel  stools  — 
very  much  resembling  chopped  spinach.  This  has,  of  course,  to  be 
borne  in  mind,  as  under  the  idea  just  mentioned,  which  prevails 
largely  amongst  those  who  do  not  reflect,  the  cathartic  might  be  re- 
peated, with  the  view  of  removing  the  very  condition  which  it  has 
induced.  Professor  Chapman  has  recommended,  that,  in  obstinate 
remittent  and  intermittent  autumnal  fevers,  cathartics  should  be  con- 
tinued until  dark,  tarry,  fetid  stools  are  discharged.  This  dark  ap- 


148 


CATHARTICS 


])earauce,  he  conceives  to  be  a glutinous  matter,  which  adheres  to 
the  intestines,  and  requires  cathartics  for  its  removal  ; but  it  appears 
by  no  means  clear,  that  it  may  not  be,  in  part,  the  effect  of  the  repeated 
employment  of  cathartics  deteriorating  the  intestinal  secretions,  in 
the  manner  referred  to. 

From  what  has  already  been  said,  it  will  obviously  be  improper 
to  administer  violent  cathartics  in  yellow  fever  ; which,  like  malig- 
nant remittents,  is  accompanied  by  malignant  gastritis  or  gastro-en- 
teritis. 

Intermittents,  — In  intermittents,  cathartics  are  rarely  employed 
for  cutting  short  the  disease.  The  imprewssion  they  make  upon  the 
nervous  system  is  not  sufficiently  intense  to  break  in  upon  the  mor- 
bid catenation.  They  are  generally  employed  in  such  cases  for  the 
purpose  of  removing  the  contents  of  the  alimentary  tube,  so  as  to 
prepare  the  way  for  the  administration  of  cinchona,  or  of  some  of  its 
preparations,  or  of  other  antiperiodics  ; and  in  the  progress  of  the  affec- 
tion, they  are  had  recourse  to  — as  in  other  maladies — for  removing 
morbid  secretions,  or  whenever  the  bowels  are  in  such  a condition 
as  to  require  their  employment. 

In  all  cases,  where  a doubt  may  exist  as  to  the  propriety  of  pre- 
scribing cathartics,  there  may  be  none  as  to  the  exhibition  of  ene- 
mata.  They  are,  indeed,  invaluable  agents,  where  the  powers  of 
life  are  so  much  reduced,  that  a rational  fear  is  entertained  as  regards 
the  administration  of  cathartics  by  the  mouth.  Even  when  food 
has  not  been  taken,  the  canal  must  be  kept  free  ; as  the  vitiated 
secretions,  and  the  product  of  the  digestion  of  the  different  sub- 
stances poured  into  the  digestive  tube  cannot  fail,  by  their  reten- 
tion, to  add  to  the  irritation. 

Eruptive  fevers. — In  all  the  exanthemata,  the  employment  of 
gentle  cathartics  is  indispensable  to  their  judicious  management.  In 
small-pox,  measles,  scarlatina,  &c., — where  the  cutaneous  surface  is 
affected  with  erethism, — the  extension  of  the  skin,  constituting  the 
mucous  membranes,  and  especially  the  gastro-intestinal,  cannot  fail 
to  participate  in  the  general  morbid  condition  ; to  have  its  secretions 
depraved ; and,  consequently,  to  require  the  administration  of  eva- 
cuants. 

With  regard  to  the  kind  of  cathartic  best  adapted  for  febrile  affec- 
tions in  general,  there  is  none  perhaps  so  available  as  the  oleum 
ricini.  Next  to  this,  the  different  salines,  especially  the  sulphate  of 
magnesia;  and,  if  stronger  cathartics  are  required, — which,  as  has 
been  remarked,  happens  far  more  rarely  than  has  been  imagined  — 
pulvis  jalap ce  compositus  — which  consists  of  jalap  and  bitartrate 
of  potassa  ; or  combinations  of  jalap  and  calomel,  or  of  rhubarb  and 
calomel,  may  be  administered.  Where  the  object  is,  as  in  fever,  to 
remove  all  offending  matters  daily  from  the  alimentary  canal,  and 
not  to  excite  a powerful  revulsion,  or  a copious  exhalation  from  the 


IN  THORACIC  AND  ABDOMINAL  INFLAMMATION. 


149 


mucous  membrane,  the  most  unirritating  agents  ought  obviously  to 
be  chosen,  and  of  these,  the  oleum  ricini  is  decidedly  the  best. 

Thoracic  and  abdominal  inflammation. — Cases  of  thoracic  inflam- 
mation do  not  exhibit  any  signal  advantage  from  the  employment  of 
cathartics.  These  can  act  only  by  virtue  of  their  depletory  or  revul- 
sive properties,  and  their  administration  must  be  guided  by  general 
principles ; but,  in  inflammatory  affections  of  the  contents  of  the  ab- 
domen, or  of  its  lining  membrane,  great  care  and  discrimination  are 
required  to  decide  upon  their  utility,  or  the  contrary. 

In  peritonitis.,  whether  implicating  the  peritoneum  proper,  or  its 
extensions  investing  the  intestines,  cathartics  have  to  be  employed 
with  caution,  for  fear  the  irritation  excited,  during  their  operation, 
should  add  to  the  inflammation.  In  such  cases,  Dr.  William  Saun- 
ders was  in  the  habit  of  saying,  that  the  best  mode  of  opening  the 
bowels  — in  enteritis  especially,  which  is  usually  attended  with  con- 
stipation — is  the  use  of  the  lancet ; and  if  this  be  followed  up  by  a 
full  sedative  dose  of  opium,  the  bowels  will  ^often  respond  without 
the  aid  of  any  cathartic.  The  constipation  is,  in  such  cases,  depend- 
ent upon  the  inflammation,  and  when  this  — the  cause  — is  removed, 
the  effect  yields  also.  Where  the  enteritis  is  seated  in  the  mucous 
coat,  irritating  purgatives  should  be  given  with  extreme  care.  A 
case,  indeed,  can  scarcely  be  imagined,  in  which  they  can  be  indi- 
cated ; yet  the  exhibition  of  a gentle  cathartic, — simply  with  the  view 
of  keeping  the  canal  free  from  morbid  secretions,  and  morbific  mat- 
ters, which  cannot  fail  to  be  present  in  such  a diseased  condition  of 
the  lining  membrane, — is  amongst  our  most  valuable  means  of  medi- 
cation. This  is  signally  the  case  in  dysentery, — in  which  the  in- 
flammation is  chiefly  seated  in  the  lower  portion  of  the  intestinal 
tube, — and  in  the  early  stages  of  cholera,  common  as  well  as  spas- 
modic. 

In  diarrhoea,  which  arises  from  irritation  of  the  lining  membrane  of 
the  intestines,  it  was  at  one  time  the  custom  to  employ  no  agents  of 
any  kind.  The  disease — as  already  remarked  — was  looked  upon 
as  an  effort  of  nature  not  to  be  interfered  with ; whilst  by  others,  an 
opposite  view  has  been  maintained,  and  astringents  have  been  ad- 
vised from  the  commencement.  Of  the  two  views,  the  latter  is  more 
markedly  erroneous,  and  mischievous  in  its  consequences.  The  dis- 
ease is  one  of  irritation,  and  the  exciting  cause  is  often  seated  in  the 
intestines  themselves;  accordingly,  it  may  be  maintained,  as  an 
almost  universal  rule,  that  gentle  cathartics  should  be  exhibited  in 
the  first  instance,  and  be  repeated  if  necessary  ; and  that  astringents 
should  not  be  used,  unless  an  asthenic  condition  should  supervene,— 
like  the  gleet,  which  generally  succeeds  to  acute  inflammation  of 
other  mucous  membranes. 

If  the  propriety  of  the  use  of  gentle  cathartics  in  the  case  of  diar- 
rhoea affecting  adults  be  admitted,  the  remark  must  apply  ci  fortiori 
to  the  diarrhoea  of  infants,  who  are  extremely  liable  to  erethism  of 
13* 


150 


CATPIARTICS 


the  dermoid  tissue,  and  to  the  formation  of  acid  in  the  primae  viae, 
which  has  often,  probably,  considerable  agency  in  the  development 
of  the  disease  ; hence  the  acid  smell  of  the  evacuations.  Often,  too, 
accompanying  this  state,  there  are  manifest  indications  of  an  inflamed 
condition  of  the  gastro-enteric  mucous  membrane. 

Dyspepsia. — In  the  variety  of  dyspepsia,  which  consists  of  an 
irritated  condition  of  the  lining  membrane  of  the  stomach,  violent 
cathartics  are  improper;  but  laxatives  may  be, — and  usually  are, — 
indicated.  Indeed,  in  atonic  dyspepsia,  the  same  system  is  advis- 
able, and  an  occasional  brisk  cathartic  may  be  exhibited  with  advan- 
tage. When  employed  in  this  manner,  a fillip  is  given  to  the 
digestive  function,  which  is  often  salutary ; whilst  if  the  cathartic  be 
often  repeated,  a degree  of  sensibility  and  irritability  may  be  induced 
in  the  bowels,  which  cannot  fail  to  add  to  the  mischief. 

Hepatic  diseases.  — In  hepatic  phlegmasia,  engorgement,  or  torpor, 
cathartics  have  been  regarded  as  eminently  useful,  by  acting  imme- 
diately on  the  radicles  of  the  portal  veins,  and  thus  diminishing  the 
quantity  of  fluid,  that  passes  to  the  liver  by  the  vena  porta.  From 
what  has  been  remarked,  regarding  the  use  of  emetics  in  jaundice, 
and  in  cholelithus  or  gallstone,  it  will  be  understood,  that  cathartics 
may  have  a beneficial  agency,  by  stimulating  the  intestinal  tube,  — 
the  excitation  being  conveyed  by  continuous  sympathy  to  the  liver 
and  its  accessaries  ; but  where  there  is  organic  mischief,  as  happens 
in  most  of  the  protracted  cases,  especially  such  as  occur  in  those  of 
broken  down  constitutions,  they  must  be  given  with  caution. 

Constipation.  — Of  the  utility  of  cathartics  in  constipation  we 
have  already  treated.  They  ought  not  — as  there  stated  — to  be 
administered  in  such  doses  as  to  act  as  powerful  local  stimulants,  on 
account  of  the  depression  which  always  succeeds  to  the  superexcita- 
tion. The  proper  mode  is  to  prescribe  them  in  small  doses,  often 
repeated,  accompanying  them  by  a properly  regulated  diet.  A brisk 
cathartic  may  obviate  the  constipation  for  the  time,  but  no  perma- 
nent cure  can  be  effected,  without  striking  at  the  root  of  the  evil,  by 
a proper  and  protracted  laxative  treatment  and  regimen. 

Colic.  — In  the  different  varieties  of  colic,  cathartics  have  been 
much  employed.  The  intestinal  pain  is  generally  caused  by  over- 
distention of  the  coats  by  flatus,  or  by  accumulated  or  irritating  ali- 
ments ; and  the  method  usually  adopted  for  removing  the  disease  is 
to  excite  the  peristaltic  action  of  the  intestines,  so  as  to  diffuse  the 
flatus  over  a larger  surface,  or  to  remove  the  source  of  irritation. 
This  may  often  be  effected  by  a union  of  cathartics  with  arom.atics, 
or,  when  the  pain  is  extremely  violent,  by  the  substitution  of  an 
opiate  for  the  aromatic,  to  allay  the  spasm,  which  forms  a part  of  the 
disease.  Perhaps  in  all  cases  of  colic,  the  best  course  is  to  premise 


IN  HEMORRHAGE. 


151 


a full  dose  of  an  opiate,  and  afterwards  to  administer  a cathartic  by 
the  mouth  or  rectum,  should  this  be  necessary. 

Hemorrhage.  — The  rules  that  guide  us  in  the  administration  of 
cathartics  in  hemorrhage,  vary  according  as  it  is  of  the  active  or  pas- 
sive kind.  In  the  former  they  may  be  proper  ; in  the  latter  not.  In 
apoplexy,  they  are  employed  both  as  depletives  and  revellents ; but 
more  for  the  latter  purpose  than  the  former.  During  the  apoplectic 
seizure,  one  of  the  best  revellents  is  a stimulating  enema,  and  this 
can  be  administered  when  deglutition  is  impracticable.  Croton  oil 
is  also  given  under  similar  circumstances.  If  a drop  of  this  be  put 
upon  the  tongue,  it  passes  by  imbibition  into  the  blood-vessels,  and 
seeks  out  the  intestinal  canal  for  its  operation,  by  virtue  of  that  sin- 
gular action  of  preference,  of  which  there  are  so  many  marked  ex- 
amples. 

In  the  epistaxiSj  that  occurs  about  the  period  of  puberty,  the  deple- 
tion and  revulsion  produced  by  a common  dose  of  sulphate  of  mag- 
nesia are  often  sufficient  to  put  a stop  to  it;  and,  whenever  signs  of 
vascular  activity  exist,  — as  in  other  hemorrhages,  — cathartics  are 
clearly  suggested.  The  same  may  be  said  of  their  employment  in 
cases  of  hcBmoptysis^  although  mental  and  corporeal  quiet  are  abso- 
lutely necessary  during  the  attack,  and  for  some  time  afterwards; 
but,  in  the  interval,  no  doubt  can  arise  as  to  the  propriety  of  their 
administration.  The  saline  cathartics,  which  operate  upon  the 
whole  of  the  intestinal  canal,  and  augment  the  exhalation  from  the 
mucous  membrane,  ought  to  be  selected. 

In  hcematemesis  or  vomiting  of  bloody  whilst  cathartics  have  been 
strongly  recommended  by  some,  they  have  been  as  warmly  repro- 
bated by  others.  The  German  practitioners  generally  object  to  them; 
yet  the  objection  does  not  appear  to  be  well  founded.  A saline  ca- 
thartic, by  acting  upon  the  whole  of  the  intestinal  canal,  developes 
a succession  of  sympathies,  during  its  operation,  that  derives  greatly 
from  the  concentration  of  vital  activity  towards  the  stomach,  which  is 
present  in  active  haematemesis.  Besides,  certain  of  the  saline  pre- 
parations— as  before  shown,  — are  somewhat  astringent  ; the  super- 
sulphate of  magnesia,  of  potassa,  or  of  soda,  for  example,  — which 
may  be  formed  extemporaneously,  by  adding  the  elixir  of  vitriol,  or 
the  dilute  sulphuric  acid,  to  a solution  of  sulphate  of  magnesia,  of 
sulphate  of  soda,  or  of  sulphate  of  potassa,  — comes  in  contact  with 
the  vessels  pouring  out  the  blood  by  rhexis  or  diapedesis,  and  by  its 
directly  astringent  properties  arrests  the  hemorrhage,  whilst  the 
agency  of  the  cathartic  may  prevent  its  recurrence.  It  has  been 
stated,  elsewhere,  that  many  cases  of  haematemesis  are  dependent 
upon  obstruction  in  some  other  organ  than  the  stomach,  — and  espe- 
cially in  the  uterus  ; and  where  there  is  torpor  of  this  last  viscus  — 
such  as  exists  in  many,  if  not  in  most  cases  of  amenorrhoea  — the 
action  of  the  cathartic  is  well  adapted  for  communicating  a salutary 
excitation  to  the  uterine  functions,  through  contiguous  sympathy. 


152 


CATHARTICS 


In  menorrhagia^  care  has  to  be  taken  in  the  administration  of  ca- 
thartics, owing  to  the  fact  just  mentioned, — that  they  excite  the 
action  of  the  uterus  by  the  sympathy  of  contiguity ; but  in  hcematu- 
ria,  such  cathartics  as  are  not  accompanied  with  a diuretic  operation 
may  be  beneficially  employed,  — the  derivation  of  nervous  and  vas- 
cular influx  from  the  urinary  organs  being  attended  with  good  effects. 
With  this  view,  the  oleum  ricini  is  had  recourse  to  with  much  ad- 
vantage. 

Hemorrhoids.  — In  hemorrhoids,  the  mildest  kinds  of  cathartics 
are  serviceable,  while  the  more  violent  are  injurious.  Obviously, 
too,  such  cathartics  should  be  avoided  as  act  upon  the  lower  portion 
of  the  alimentary  tube,  unless  some  addition  be  made  to  them,  which 
rids  them  of  their  objectionable  features.  Accordingly,  when  aloes 
is  given,  it  is  generally  in  small  doses,  and  with  the  addition  of  some 
narcotic,  — as  hyoscyamus.  The  mild  chloride  of  mercury  is  a 
cathartic,  which  generally  acts  more  energetically  upon  the  upper 
portion  of  the  intestines;  but,  with  some,  it  irritates  the  rectum,  and, 
consequently,  such  individuals  should  avoid  its  use  when  affected 
with  hemorrhoids  or  any  disease  of  the  rectum.  Castor  oil,  and 
sulphur,  are  the  best  laxatives  in  such  cases.  These  remarks  apply 
equally  to  procidentia,  in  which  drastic  cathartics  could  not  fail  to 
do  mischief. 

Pregnancy.  — In  pregnancy,  powerful  cathartics  must  be  avoided, 
for  reasons  that  have  been  previously  assigned. 

Head  affections.  — In  various  head  affections,  and  especially  in  en- 
cephalitis^ whether  involving  the  brain  or  its  membranes,  or  both,  — 
cathartics  would  clearly  be  advantageous,  by  virtue  of  the  revulsion 
they  effect,  did  not  the  inconvenience,  to  which  the  patient  is  sub- 
jected by  the  motion  necessarily  attendant  on  their  operation,  often 
preclude  their  employment. 

In  mania.,  they  are,  at  times,  absolutely  required,  in  consequence 
of  the  torpor,  that  occasionally  exists  in  the  intestinal  tube.  Owing 
to  this  cause,  an  accumulation  sometimes  takes  place  in  the  large  in- 
testines to  a surprising  extent,  and  the  use  of  the  scoop  is  required  to 
remove  the  indurated  faeces  that  have  collected  in  the  rectum  ; after 
which,  injections  of  cold  water  may  be  thrown  into  the  large  intes- 
tine to  restore  its  tone. 

Owing  to  the  torpor  of  the  nerves  of  the  tube,  or  rather  to  the 
cerebral  abstraction  and  excitation,  which  prevent  the  usual  sensi- 
tive impressions  from  being  duly  appreciated,  the  most  violent  dras- 
tics are  occasionally  demanded  — as  oleum  tiglii,  or  elaterium  — 
and  even  these  are  often  ineffectual,  unless  blood-letting  be  premised, 
which,  by  reducing  the  nervous  energy,  enables  smaller  doses  to 
produce  the  wished-for  operation.  Sometimes,  considerable  diffi- 
culty is  experienced  by  the  administration  of  any  remedy  by  the 
mouth,  — the  patient  obstinately  closing  the  jaws,  and  resisting 


IN  NEUROSES. 


153 


every  effort  to  separate  them.  This  determination  may  frequently 
be  broken  in  upon — especially  after  blood-letting — by  pressing 
strongly  on  the  parotid  gland,  which  occasions  so  much  pain,  that 
the  maniac  yields,  and  the  jaw  is  depressed. 

JYeuroses.  — In  all  the  neuroses,  it  is  important  to  keep  the  intes- 
tinal tube  free  ; as  irritations,  seated  there,  re-act  upon  the  cerebro- 
spinal axis,  and  add  to  the  mischief. 

Hysteria j which  is  ranked,  though  improperly,  by  Pinel,  in  ac- 
cordance with  antiquated  notions,  as  a nevrose  de  la  generation^  is 
often  associated  with  this  condition  of  the  bowels ; and  therefore 
requires  the  use  of  cathartics.  Great  nervous  torpor  of  the  whole 
system  is  also  present  in  many  cases  of  this  protean  malady,  re- 
quiring the  administration  of  cathartics  as  revellents,  both  by  the 
mouth,  and  rectum. 

Under  the  head  of  emetics  it  was  remarked,  that  irritations  of  the 
stomach  and  bowels,  produced  by  improper  diet  or  by  morbid  secre- 
tions, are  a grand  exciting  cause  of  epilepsy^  as  well  as  of  infantile 
convulsions.  Cathartics  are,  therefore,  almost  universally  proper  un 
these  alarming  attacks  ; but  care  must  be  taken  not  to  repeat  them 
sufficiently  often  to  develope  the  sensibility  of  the  tube,  as  they 
might  react  on  the  cerebro-spinal  axis,  and  augment  the  very  mis- 
chief which  they  were  administered  to  remove. 

Chorea — a disease  of  the  nervous  centres,  accompanied  with 
great  torpor  of  the  digestive  function  — requires  a union  of  tonics 
with  cathartics  for  its  removal.  Dr.  Hamilton,  of  Edinburgh,  — an 
authority,  who  has  been  the  cause  of  much  valuable  use,  and  at  the 
same  time,  of  much  abuse  of  the  cathartic  medication,  — places  his 
main  reliance  on  cathartics,  in  the  cure  of  this  singular  affection. 

One  of  the  varieties  of  trismus  — the  trismus  nascentium  — or 

lockjaw  of  the  new-born,”  is  often  dependent  upon  irritations 
seated  in  the  intestinal  canal,  and  is  occasionally  removable  by  gentle 
cathartics,  as  the  oleum  ricini.  In  this  part  of  the  globe,  it  is  rarely 
witnessed  ; but  in  the  warmer  regions,  it  is  a fatal  malady.  At  the 
Havana,  according  to  Don  Ramon  de  la  Sagra,  of  one  hundred  chil- 
dren dying  under  ten  years  of  age,  nineteen  per  cent,  amongst  the 
whites  perish  of  it  within  the  first  seven  days,  and  twenty-four  per 
cent,  amongst  the  infants  of  color.  There,  the  affection  is  called  the 
“ disease  of  the  seven  days”  {mal  de  los  siete  dias.) 

In  violent  cases  of  tetanus  in  the  adult,  cathartics  constitute  one 
of  the  agents  to  which  recourse  is  almost  invariably  had,  along  with 
other,  and  more  essential  remedies,  — as  narcotics.  When  swallow- 
ing is  impracticable,  stimulating  enemata  are  often  administered,  with 
the  view  of  exciting  a new  impression  by  revulsion ; or  opium  is 
given  in  the  same  manner,  where  the  object  of  the  practitioner  is  to 
endeavour  to  overpower,  by  sedatives,  the  inordinate  erethism  of  the 
cerebro-spinal  axis.  When  deglutition  can  be  effected,  a union  of 
cathartics  and  opiates  is  often  employed  to  fulfil  similar  views.  The 


154 


CATHARTICS. 


oleum  tiglii  is,  in  these  cases,  a useful  cathartic,  both  when  deglu- 
tition exists,  and  when  it  is  impracticable. 

Dropsies.  - — Cathartics  are  among  the  most  valued,  and  valuable 
agents  in  the  treatment  of  dropsies,  especially  when  these  are  of  an 
active  kind.  In  the  passive,  they  must  necessarily  be  used  with 
more  caution.  The  division  of  cathartics,  to  which  recourse  is  had, 
is  that  of  drastics,  such  of  those  especially  as  produce  copious  watery 
discharges,  — or  which,  in  other  words,  act  powerfully  on  the  secre- 
tory apparatus  of  the  mucous  membrane  of  the  alimentary  canal. 
Elaterium  is  one  ; but  it  must  be  cautiously  administered,  on  account 
of  the  difficulty  that  exists  in  regulating  its  operation.  Calomel,  and 
gamboge  are  often  selected  for  this  agency.  These  hydragogues  — 
<is  before  mentioned  — act  in  two  ways  in  the  curation  of  dropsy  ; 
first,  they  diminish  the  amount  of  circulating  fluid,  and  thus  add  to 
the  activity  of  imbibition  ; and  secondly,  they  excite  a powerful  re- 
vulsion, which  gives  rise,  indirectly,  to  a sorbefacient  agency. 

•Intestinal  worms.  — Cathartics  are  often  employed  as  anthelmin- 
tics ; but  their  main  effect  can  only  be  the  removal  of  existing  worms  ; 
they  do  not  prevent  their  re-formation  ; besides,  if  often  given,  they 
may  debilitate  the  system  generally,  and  the  digestive  function  in 
particular,  and  thus  favour  the  predisposition  to  the  development  of 
those  parasites  ; but,  on  the  other  hand,  an  occasional  brisk  cathartic 
may  give  rather  than  diminish  tone,  by  breaking  in  upon  the  mono- 
tonous execution  of  functions,  and  exerting  a salutary  impression  of 
excitation. 

Such  are  the  chief  disorders  and  purposes  for  which  cathartics  are 
administered.  It  is  obviously  almost  as  impracticable,  as  it  is  un- 
necessary, to  refer  to  every  case,  in  which  their  employment  may 
seem  to  be  indicated.  Their  main  effects  on  the  general  system  are, 
— depletion  and  revulsion  ; and  a wise  discrimination  will  suggest 
the  particular  cases,  in  which  such  agency  is  demanded.  Their  im- 
mediate effects  upon  the  parts  with  which  they  come  in  contact  are 
obvious  ; and  a very  slight  degree  of  reflection  — after  the  patholo- 
gical lesion  has  been  correctly  appreciated  — will  enable  the  practi- 
tioner to  decide  as  to  the  propriety  of  their  administration. 


SPECIAL  CATHARTICS  — MANNA. 


155 


SPECIAL  CATHARTICS. 

I.  Laxatives  or  Mild  Cathartics. 

1.  MANNA. 

Manna  is  the  concrete  juice  of  Ornus  Europce'a,  Frax'inus  Ornus^ 
or  Flowering  Ash ; Sex.  Syst.  Diandria  Monogynia  ; Nat.  Ord. 
OleacetC  (Lindley) ; a native  of  the  south  of  Europe,  especially  of 
Calabria  and  Sicily.  It  is  chiefly  obtained  by  making  incisions  in 
the  stem.  It  also  issues  in  part  spontaneously  from  fissures,  and  in 
part  from  punctures  made  by  an  insect,  the  Tettigo’nia  Orni  or 
CMda  Orni.  The  juice,  as  it  issues,  is  nearly  colourless,  and  some- 
what viscid  ; but  it  soon  concretes  in  the  sun  into  a yellowish  opaque 
substance. 

Some  of  it  is  permitted  to  fall  on  the  ground,  or  on  leaves  placed 
to  receive  it,  or  to  trickle  down  the  trunk  ; but  where  care  is  taken 
the  leaves  of  the  ornus  are  stuck  into  the  bark  below  the  incisions, 
which  guide  it  to  receptacles  formed  of  leaves  of  the  Cactus  Optin' tia 
or  Indian  Fig ; and  straws  and  twigs  are  inserted  into  the  incisions 
so  that  the  juice  concretes  in  the  form  of  stalactites,  and  is  readily 
detached  clear  from  the  bark.  The  collection  of  manna  commences 
in  July,  and  continues  till  October,  — the  best  kind  being  obtained 
during  the  month  of  August,  or  in  the  height  of  the  season  ; and  the 
inferior  qualities  towards  the  close. 

Manna  is  imported  chiefly  from  Palermo  and  Messina,  but  likewise 
Lorn  various  parts  of  Italy  and  Sicily.  The  quantity,  on  which  duty 
was  paid  in  England,  in  1839,  according  to  Dr.  Pereira,  was  13,493 
pounds. 

There  are  several  varieties  of  manna  met  with  in  commerce.  The 
one  which  is  the  purest,  is  Flake  Manna  — Manna  Cannula! ta  — 
which  is  in  irregularly  shaped  pieces  resembling  stalactites,  and  ob- 
tained in  the  manner  above  mentioned.  It  is  light,  brittle,  of  a 
whiteor  pale  yellowish  white  colour;  has  a faint,  rather  pleasant  odour, 
and  a sweet  somewhat  peculiar  taste,  becoming  ultimately  rather 
acrid.  When  broken,  flake  manna  has  a crystalline  or  granular 
structure. 

Manna  in  sorts  or  Common  Manna  consists  of  whitish  or  yellowish 
fragments  similar  to  the  last  variety,  but  smaller,  and  mixed  with  a 
soft,  viscid,  uncrystallised  brownish  mass,  like  that  which  constitutes 
the  commonest  variety  — the  fat  or  fatty  manna,  which  is  in  the 
form  of  a soft  viscous  mass,  of  a dirty  yellowish-brown  colour,  con- 
taining few  crystalline  fragments,  and  full  of  impurities.  Under  the 
name  Sicilian  Tolfa  Manna,  Dr.  Pereira  describes  an  inferior  kind, 
corresponding  to  the  manna  in  sorts.  It  is  thought  by  him  to  cor- 


156 


SPECIAL  CATHARTICS. 


respond  in  quality  to  Tolfa  Manna,  produced  near  Civita  Vecchia, 
which  is  but  little  valued. 

Manna  has  frequently  been  subjected  to  analysis,  and  been  found 
to  contain  about  60  per  cent,  of  a peculiar  sweet  principle  called 
mannite  ; a little  common  sugar,  partly  crystalline  and  partly  uncrys- 
tallisable  ; extractive  matter,  and  about  32  per  cent,  of  moisture. 

The  extractive  matter,  which  is  nauseous,  has  been  regarded  as 
the  laxative  principle ; yet  mannite  would  seem  to  be  as  laxative 
as  manna  itself. 

Manna,  like  sugar,  is  nutritive  ; but,  it  is  not  used  with  us  on 
account  of  this  property.  It  is  a gentle  laxative,  but  does  not 
always  act  without  inducing  tormina.  By  females  and  children  it 
is  occasionally  taken  alone  ; but  more  frequently  it  is  prescribed 
as  an  adjunct  to  other  remedies  of  the  same  class,  as  senna,  and 
sulphate  of  magnesia,  whose  taste  it  somewhat  conceals,  whilst  it 
adds  to  their  cathartic  agency.  According  to  the  author’s  taste, 
however,  the  addition  of  the  manna  is  no  improvement. 

The  dose  of  manna,  for  an  adult,  is  from  one  to  two  ounces ; for 
children  from  one  to  three  drachms.  In  the  case  of  the  former  it 
may  be  eaten  ; of  the  latter,  it  may  be  taken  dissolved  in  water, 
simple  or  aromatic,  or  in  tea  or  coffee. 

Mannite.  — Mannite  has  been  brought  forward  as  one  of  the 
‘‘  new  remedies.”  It  is  obtained  by  treating  manna  in  tears  with 
boiling  alcohol ; then  filtering  and  suffering  it  to  crystallise  ; by 
rest  and  refrigeration  mannite  is  precipitated  in  small,  beautiful, 
white  needles. 

It  is  used  under  the  same  circumstances  as  manna,  and  the  dose 
is  much  the  same. 

2.  SULPHUR. 

Sulphur,  of  the  Pharmacopoeia  of  the  United  States,  is  the  sub- 
limed sulphur  of  some  other  pharmacopoeias.  It  is  found  both  in 
the  inorganic  and  the  organised  kingdom.  In  the  former,  it  occurs 
either  imbedded  in  rocks  — common  native  sulphur  ; or  produced  by 
volcanic  action  — by  sublimation  — volcanic  sulphur.  In  the  or- 
ganised kingdom,  it  is  found  in  many  plants  ; in  the  liliacese,  for 
example,  in  garlic  ; in  the  cruciferse,  in  mustard  ; and  in  assafoe- 
tida  of  the  umbelliferae.  It  is  also  found  in  certain  animal  sub- 
stances, as  eggs,  urine,  &c.  In  combination,  in  the  state  of  sulphuric 
acid,  it  occurs  extensively. 

Sulphur  may  be  procured  by  purifying  native  sulphur,  or  by  de- 
composing the  native  sulphurets  ; but  the  sulphur  of  commerce  is 
generally  obtained  in  the  former  way.  It  is  brought  chiefly  from 
Italy  and  Sicily.  During  the  year  1834,  according  to  McCulloch, 
not  less  than  507,808  cwt.  of  rough  brimstone  were  imported  into 
England,  of  which  485,756  cwt.  were  from  Italy,  or  rather  Sicily. 


SULPHUR. 


157 


Native  sulphur  is  met  with  in  small  quantities  in  different  parts 
of  the  United  States. 

Crude  sulphur  is  prepared  from  native  sulphur,  either  by  being 
subjected  to  a rude  process  of  fusion,  or  by  a process  of  distilla- 
tion in  earthen  pots.  In  this  state,  it  is  imported  and  purified. 
The  process,  formerly  adopted,  was  to  submit  it  to  fusion  in  an  iron 
caldron  ; when  the  earthy  impurities  subsided,  and  the  liquid  sul- 
phur was  ladled  out  and  cast  into  moulds,  so  as  to  form  the  roll 
sulphur  or  roll  brimstone.  The  improved  method  of  purification  is 
to  distil  it  in  an  iron  still,  the  sulphur  being  allowed  to  pass  into  a 
chamber,  on  the  walls  of  which  it  is  deposited,  in  the  form  of  flowers 
of  sulphur.  If,  instead  of  permitting  the  sulphur  to  enter  the  sulphur 
chamber,  it  be  made  to  pass  into  an  appropriate  receiver,  the  sulphur 
distils  over,  and  condenses  into  a liquid,  which,  when  solidified, 
constitutes  the  refined  sulphur  of  commerce.  If  this  be  cast  in 
wooden  moulds,  it  forms  the  stick  or  roll  or  cane  sulphur ^ or  brim- 
stone. 

Flowers  of  sulphur,  or  solid  sulphur,  may  be  prepared  from  the 
metallic  sulphurets,  by  similar  processes. 

The  dregs  that  remain  after  the  purification  of  sulphur  constitute 
sulphur  vivum,  formerly  used  externally  ; but  now  never  employed 
except  by  the  veterinary  surgeon.  It  has  hence  obtained  the  name 
of  horse  brimstone. 

Sublimed  sulphur,  prepared  by  any  of  these  methods,  contains 
more  or  less  sulphuric  acid,  owing  to  some  of  it  undergoing  com- 
bustion. This  can  be  removed  by  washing,  after  which  we  have 
the  sulphur  sublimatum  lotum  of  certain  of  the  pharmacopoeias,  and 
of  the  United  States  Pharmacopoeia  of  1830.  In  the  last  edition, 
however.  Sulphur  means  the  sublimed  article  ; and  Sulphur  lotum 
or  washed  sulphur.^  sublimed  sulphur  thoroughly  washed  with  water. 
As  met  with  in  the  shops,  it  is  in  fine  powder,  of  a bright  yellow 
colour,  and  of  a peculiar  smell  and  taste.  It  is  insoluble  in  water, 
but  soluble  in  alcohol,  ether,  and  the  oils, — both  fixed  and  volatile. 
It  is  wholly  volatilised  by  heat,  and  ought  not  to  change  the  colour 
of  litmus  paper. 

Sulphur  is  one  of  the  gentlest  laxatives  ; producing  scarcely  any 
augmented  secretion  from  the  follicles  and  exhalants  of  the  intes- 
tines. Being  so  mild  in  its  action,  it  has  been  given  in  cases  of 
pregnant  females  ; and  is  a common  laxative  in  hemorrhoidal  affec- 
tions. When  it  is  necessary  to  add  to  its  cathartic  agency,  mag- 
nesia, or  bitartrate  of  potassa  may  form  the  adjunct.  The  great  ob- 
jection to  sulphur  is,  that  even  its  internal  use  occasions  the  patient 
to  exhale  a disagreeable  sulphurous  odour,  owing  to  the  formation 
of  sulphuretted  hydrogen.  Sulphur  in  combination  with  bitartrate 
of  potassa,  or  alone,  mixed  with  molasses,  has  long  been  a favourite 
“purifier  of  the  blood,”  and  is  often  given,  spring  and  fall,  as 
a domestic  remedy.  Its  dose,  as  a cathartic,  is  from  5j  to  ^ss. 

VOL.  I.  — 14 


158 


SPECIAL  CATHARTICS. 


It  may  be  given,  as  before  remarked,  in  molasses,  or  diffused  in 
milk. 

SULPHUR  PRiECIPlTA'TUM,  PRECIP  ITATED  SULPHUR  or  lac  sulph'uris,  pre- 
pared by  decomposing  a sulphuret  of  lime,  by  means  of  chlorohydric 
acid,  was  officinal  in  the  British  Pharmacopoeias,  and  is  still  so  in  that 
of  the  United  States.  It  possesses  no  advantages  over  sulphur  lotum. 
It  is  much  whiter,  and  in  a state  of  fine  division.  It  is  said  to  be 
exceedingly  liable  to  adulteration,  and,  on  this  account,  has  been  left 
out  of  the  British  Pharmacopoeias.  According  to  Dr.  Pereira,  in  the 
preparation  of  nearly  the  whole  of  the  precipitated  sulphur,  sul- 
phuric acid  is  substituted  for  the  chlorohydric,  by  which  the  product 
contains  about  two-thirds  of  its  weight  of  sulphate  of  lime ; and  he 
adds,  that  he  was  informed  by  an  extensive  manufacturer  of  the  arti- 
cle, that  a firm,  whose  name  he  mentions,  was  almost  the  only  one 
that  bought  the  pure  kind. 

Pure  precipitated  sulphur,  like  sublimed  sulphur,  is  wholly  vola- 
tilised by  heat. 

3.  MAGNE'SIA.— MAGNE'SIA. 

Magne'sia,  cal'cined  or  burnt  magne'sia^  is  prepared  by  exposing  car- 
bonate of  magnesia  to  a red  heat  in  an  earthen  vessel,  until  the  car- 
bonic acid  is  wholly  expelled,  and  the  protoxide  of  magnesium  re- 
mains. 

It  is  a light,  white  powder,  devoid  of  smell,  and  almost  tasteless. 
Its  specific  gravity  is  2.3.  When  moistened  with  water,  it  exhibits 
an  alkaline  reaction.  It  is  very  sparingly  soluble  in  water,  and  less 
so  in  boiling  water  than  in  cold.  It  absorbs  carbonic  acid  ; and, 
therefore,  should  be  kept  from  contact  with  air. 

The  tests  of  its  purity,  as  given  in  the  Pharmacopoeia  of  the  United 
States,  (1842,)  are, — that  it  should  dissolve  wholly  without  efferves- 
cence in  dilute  chlorohydric  acid,  which  woidd  prove  the  absence  of 
carbonate  of  magnesia,  with  which  it  is  often  mixed,  and  that  the 
solution  in  dilute  chlorohydric  acid  should  yield  no  precipitate  with 
oxalate  of  ammonia,  or  chloride  of  barium,  — proving  the  absence  of 
lime  and  of  sulphates. 

Magnesia  is  a gentle  laxative,  and  as  such  is  employed  in  preg- 
nancy, affections  of  the  rectum,  &c.,  where  mild  aperients  are  need- 
ed. It  is  especially  valuable  where  constipation  is  attended  with  car- 
dialgia  from  too  great  a secretion  of  the  gastric  acids  ; and  in  chil- 
dren it  forms  an  admirable  laxative,  owing  to  the  great  predominance 
of  acid  with  them.  It  is  also  readily  taken  by  them,  when  mixed 
with  milk,  and  sweetened.  It  is  an  excellent  adjunct  to  carminative 
mixtures,  where  it  is  advisable  to  increase  the  peristole  of  the  bowels  ; 
and  is  often  prescribed  for  this  purpose  to  children.  {Magnes.  gr. 
XV  ; 01.  aniai^  seu  OL  carui  gtt.  iij  ; Mquce  f.  oj  ; Sacchar.  3i*  M.  Dose, 
a tea-spoonful  occasionally.) 

Where  diarrhoea  is  attended  with  acidity,  as  it  often  is,  magnesia 


FICUS. 


159 


may  be  needed  to  facilitate  the  removal  from  the  bowels  of  the  re- 
dundant acid  ; but  where  it  is  desirable  to  neutralise  the  acid,  and  at 
the  same  time  to  induce  a constipating  effect,  prepared  chalk  should 
be  prescribed. 

The  dose  of  magnesia  as  a cathartic,  to  an  adult,  is  from  a scruple 
to  a drachm  ; to  infants  from  two  to  eight  or  ten  grains.  Occasion- 
ally it  does  not  operate,  owing  to  its  not  meeting  with  acid  in  the  sto- 
mach : its  action,  in  such  cases,  may  be  facilitated  by  drinking  le- 
monade, which  forms  a citrate  of  magnesia  that  acts  as  a mild  aperient. 

It  is  proper  to  remark,  that  where  magnesia  has  been  taken  for  a 
long  time,  and  in  large  quantities,  it  has  occasionally  accumulated 
in  the  bowels,  and  given  rise  to  unpleasant  effects. 

4.  MAGNE'SI^  CAR^BONAS.— CAR'BONATE  OF  MAGNE'SIA. 

Carbonate  of  magnesia^  subcarbonate  of  magnesia^  or  magnesia  alha^ 
occurs,  although  not  in  great  abundance,  as  a mineral  ; but  that  of 
the  shops  is  prepared  on  a large  scale  by  decomposing  sulphate  of  mag- 
nesia by  an  alkaline  carbonate  ; the  consequence  of  which  is  the  pre- 
cipitation of  carbonate  of  magnesia.  As  it  is  prepared  by  the  whole- 
sale chemist,  no  formula  for  it  is  given  in  the  Pharmacopoeia  of  the 
United  States.  The  greater  part  of  that  which  is  used  in  this  coun- 
try is  imported  from  Scotland.  In  New  England,  it  is  prepared  from 
the  bittern  of  the  salt  works,  which  consists  chiefly  of  sulphate  and 
muriate  of  magnesia  ; and  in  Baltimore,  it  is  made  from  the  sulphate 
of  magnesia  extensively  prepared  there. 

Carbonate  of  magnesia  is  a light,  white,  inodorous,  and  almost 
insipid  powder.  It  is  nearly  insoluble  in  water,  but  readily  dissolves 
in  aerated  or  carbonic  acid  water.  It  is  distinguishable  from  pure 
magnesia  by  effervescing  with  acids.  Its  adulterations  are  the  same 
as  those  of  magnesia,  and  may  be  detected  nearly  in  the  same 
manner. 

The  therapeutical  properties  of  carbonate  of  magesia  are  almost 
the  same  as  those  of  magnesia.  As,  however,  it  contains  carbonic 
acid,  this  is  set  at  liberty,  when  the  salt  meets  with  acid  in  the  sto- 
mach, and  is  apt  excite  flatulence.  Its  dose,  as  a laxative,  is  from 
half  a drachm  to  a drachm,  given  in  milk,  with  which  neither  it  nor 
magnesia  mixes  well  without  great  care.  Its  admixture  is  facilitated 
by  first  rubbing  it  with  syrup. 

A fluid  magnesia  has  been  much  recommended  of  late  by  Sir 
James  Murray,  and  Mr.  Dinneford.  The  preparation  of  the  latter  is 
said  to  contain  from  17  to  19  grains  of  carbonate  of  magnesia  in 
every  fluidounce.  It  is  a condensed  solution  of  magnesia  in  carbo- 
nated water. 


5.  FICUS.— FIGS. 

Figs,  in  the  Pharmacopceia  of  the  United  States,  mean  the  dried 


160 


SPECIAL  CATHARTICS. 


fruit  of  Ficus  Ca'rica,  the  Fig  Tree, 
which  is  a native  of  Asia  and  Southern 
Europe,  but  cultivated  in  the  gardens 
of  this  country.  The  figs,  when  ripe, 
are  dried  in  the  sun  or  in  ovens,  and 
are  afterwards  packed  in  drums,  bas- 
kets or  boxes.  They  are  chiefly  brought 
to  the  United  States  from  Smyrna  ; and 
the  Turkey  or  Smyrna  figs  are  the 
largest  and  sweetest ; and  therefore  the 
best.  Dried  figs  form  a very  consider- 
able article  of  commerce  in  Provence, 
Italy  and  Spain,  besides  affording,  as 
in  the  east,  a principal  article  of  suste- 
nance for  the  population.  The  annual 
importation  into  Great  Britain  has  been  estimated  at  about  20,000  cwt. 

The  chief  constituents  of  figs  are  mucilage  and  sugar  of  figs,  which 
greatly  resembles  the  sugar  of  the  grape. 

Like  other  saccharine  articles,  figs  are  laxative  ; and,  by  virtue  of 
their  mucilage,  they  are  demulcent  likewise.  They  are  eaten  in 
cases  of  habitual  torpor  of  the  bowels;  and  they  enter  into  the  com- 
position of  the  Confectio  Sennce  of  the  Pharmacopoeia. 

The  split  fig  retains  heat  well,  and  is,  therefore,  occasionally  ap- 
plied to  inflammatory  tumours  to  promote  suppuration. 

6.  CAS'SIA  FIS'TUL A.— PURGING  CAS'SIA. 

Cassia  Fistula  is  the  fruit  of  Cas'sia  Fis'tula^  Cathartocar'pus  Fis'- 
iula^  Pudding  pipe  tree  or  Purging  Cassia ; Sex.  Svst.  Decandria 
Monogynia  ; Nat.  Ord.  Leguminosse,  which  is  supposed  to  have 
been  originally  a native  of  Upper  Egypt  and  India,  whence  it  has 
spread  to  various  places.  It  is  now  found  abundantly  in  Hindusthan, 
China,  the  East  India  and  V/est  India  Islands,  and  in  South  America. 

The  fruit — the  officinal  portion  — as  imported  from  the  East  and 
West  Indies  and  South  America  — is  in  pods,  from  nine  inches  to 
two  feet  in  length,  which  are  cylindrical,  slightly  curved,  and  of  a 
dark  brown,  nearly  black  colour.  Internally,  the  pod  is  divided  into 
numerous  thin  transverse  partitions,— and  each  of  these  contains  a 
hard,  flattened,  oval-shaped  seed,  surrounded  by  a soft,  black  pulp 
resembling  an  extract. 

CAS'SLE  FISTULiE  PULPA,  PULP  OF  PURGING  CASSIA,  is  separated  by  pour- 
ing boiling  water  on  the  bruised  pods  to  soften  the  pulp  ; then  strain- 
ing first  through  a coarse  sieve,  and  afterwards  through  a hair  one, 
and  boiling  down  to  a proper  consistence.  When  subjected  to 
analysis,  the  common  or  African  variety  yielded  61  per  cent,  of  sugar  ; 
the  American  69  per  cent. 


Fig.  11. 


Ficus  Carica. 


PllUNUM. 


161 


Cassia  pulp  is  a laxative  in  a small  dose  ; in  a larger  it  is  purga- 
tive, but  it  does  not  act  kindly  ; being  apt  to  induce  nausea,  and  tor- 
mina. It  is  rarely  prescribed  alone, — never  perhaps  in  this  country  ; 
but  it  enters  as  one  of  the  laxative  ingredients  into  the  Confectio 
Sennce  of  the  Pharmacopoeia  of  the  United  States.  Its  dose  as  a mild 
laxative  is  stated  to  be  5j.  to  3ij ; as  a purgative,  ^ij.  to  sj. 

7.  TAMARIN'DUS.— TAM'ARINDS. 

Tamarind  is  the  preserved  fruit  of  Tamarin'dus  In'dica ; Sex. 
Syst.  Monodelphia  Triandria  ; Nat.  Ord.  Leguminosae,  a tree  which 
is  indigenous  in  the  East  and  West  Indies.  The  fruit  is  a pod  from 
two  to  six  inches  long,  which  consists  of  a ligneous  husk,  enclosing 
a pulpy  texture,  which  is  traversed  by  numerous  branching  fibrils, 
within  which  one  or  more  seeds  are  imbedded.  The  officinal  part  is 
the  pulp  between  the  seeds  and  husk.  It  is  usually  imported  along 
with  the  seeds  and  preserved  in  sugar.  Tamarinds  are  brought  to 
this  country  from  the  West  Indies. 

When  subjected  to  analysis,  the  pulp  yields  citric,  tartaric  and 
malic  acids  ; bitartrate  of  potassa  ; sugar,  gum,  vegetable  jelly,  paren- 
chyma and  water.  It  has  an  agreeable,  sweetish  acid  taste,  and 
readily  imparts  its  properties  to  water. 

Tamarinds  are  gently  laxative,  but  they  are  rarely  given  alone. 
They  were  formerly  prescribed  with  other  cathartics,  as  with  infusion 
of  senna;  but  they  have  been  considered  — probably  on  insufficient 
grounds  — to  diminish  the  operation  both  of  it  and  of  the  resinous 
cathartics.  They  form  part  of  the  Confectio  Sennce  of  the  Pharma- 
copoeia of  the  United  States  ; for  which  purpose  they  are  digested 
with  a small  quantity  of  water,  until  they  become  of  uniform  consist- 
ence ; after  which  the  seeds  and  filaments  are  separated  by  pressing 
through  a hair-sieve.  This  is  the  TAMARINDI  PULPA  or  Pulp  of  Tama- 
rinds of  the  Pharmacopoeia. 

8.  PRUNUM  — PRUNES. 

Prunes  are  the  dried  fruit  of  Prunus  domes’tica^  the  Plum-tree; 
Sex.  Syst.  Icosandria  Monogynia  ; Nat.  Ord.  Rosacese ; which  is 
cultivated  in  temperate  regions  every  where;  but  is  supposed  to  be 
a native  of  Syria,  especially  near  Damascus.  The  dried  fruits  are 
called  Prunes  or  French  plums.  They  are  chiefly  imported  from  the 
south  of  France,  and  are  derived  from  the  Saint  Julien  variety;  the 
table  prunes  being  obtained  from  the  larger  kinds  of  plum  — as  the 
Saint  Catharine  and  the  Reine-Claude  or  green-gage. 

The  fresh  ripe  fruit,  according  to  M.  Berard,  contains  about  twenty 
per  cent,  of  solid  matter,  of  which  upwards  of  eleven  per  cent,  is 
sugar,  and  five  gum,  — the  remainder  being  constituted  of  the  malic 
and  pectic  acids,  albumen  and  ligneous  fibre.  The  proportion  of 

14* 


162 


SPECIAL  CATHARTICS. 


sugar,  Is  increased  in  the  process  of  drying;  but  this  matter  has  not 
been  investigated. 

Prunes  are  laxative,  and  when  taken  in  the  evening  are  sufficient, 
with  many,  to  cause  the  evacuation  of  the  bowels  on  the  following 
morning.  Generally,  they  are  taken  stewed,  as  diet,  in  cases  of 
costiveness,  or  in  febrile  and  other  diseases  in  which  it  is  desirable 
to  keep  the  intestinal  canal  gently  free.  The  sugar  and  mucilage, 
which  they  contain,  renders  them  also  nutritious.  They  are  some- 
times added  to  cathartic  infusions  and  decoctions  to  improve  their 
taste  and  increase  their  effect. 

The  Pulp  of  prunes^  Pruni  Pulpa,  is  made  by  softening  the  prunes 
in  the  vapour  of  boiling  water,  and  having  separated  the  stones, 
beating  the  remainder  in  a marble  mortar  and  pressing  it  through  a 
hair  sieve.  It  enters  into  the  composition  of  the  Confectio  Sennee. 

9.  SINATIS.  — MUSTARD. 

The  seeds  of  White  mustard^  Sina' pis  alha^  unbruised,  have  been 
long  recommended,  in  the  dose  of  a table-spoonful,  in  cases  of  torpor 
of  the  digestive  function.  They  had  almost  fallen  into  disuse,  how"- 
ever,  when  Sir  John  Sinclair — the  author  of  a ‘‘  Code  of  Health  and 
Longevity  f published  an  article  in  a periodical,  strongly  recommend- 
ing them  to  the  aged,  as  a means  of  preserving  their  health,  by 
stimulating  the  digestive  function  to  greater  activity,  and  at  the  same 
time  keeping  the  action  of  the  intestinal  canal  free.  They  may  be 
taken  three  or  four  times  a day,  mixed  with  molasses.  It  would 
seem,  however,  that  their  use  in  such  large  quantities,  in  torpid 
habits,  is  not  totally  devoid  of  danger.  They  have  been  known  to 
accumulate  in  the  csecum  and  appendix  cseci,  and  are  said  to  have 
induced  fatal  inflammation  of  the  stomach  and  bowels. 

Besides  the  above  officinal  laxatives,  there  are  some,  which  are 
occasionally  used  as  such,  but  whose  prominent  effects  are  of  a 
different  nature.  These  will  require  but  a passing  notice. 

10.  OTeum  amyg'dala:.  Oil  of  almonds;  and  OTeum  Oli'va:, 
Olive  oil.  The  properties  of  these  oils  are  described  elsewhere. 
Both  of  them  are  mild  laxatives  in  the  dose  of  f.  oss.  to  f.  .Ij  ; although 
not  often  used  as  such.  When  prescribed,  it  is  generally  in  affections 
of  the  alimentary  canal,  or  of  the  genito-urinary  apparatus,  when  it 
may  be  desirable  to  give  laxatives,  that  will  not  enter  into  the  blood- 
vessels, and  irritate  the  kidneys  or  urinary  passages.  A common 
laxative  for  new-born  children,  in  England,  is  a mixture  of  equal 
parts  of  Oil  of  almonds  and  Syrup  of  violets^  or  Syrup  of  Roses  — 
the  dose  of  which  is  a tea-spoonful;  but  olive  oil  and  simple  syrup 
are  equally  effective. 


OLEUM  RICINI. 


163 


II.  Purgatives^  or  Brisk  Cathartics. 

O'LEUM  RIC'  INL  — CASTOR  OIL. 

The  Castor  oil  plant.,  Rid'inus  commu'nis  or  Fig:.  12, 

Palma  Christi;  Sex.  Syst.  Monoecia  Monadel- 
phia;  Nat.  Ord.  Euphorbiacece,  is  probably  a 
native  of  the  East  Indies,  Greece  and  Africa, 
whence  it  was  introduced  into  the  West  Indies 
and  the  American  continent.  It  is  now  largely 
cultivated  in  many  parts  of  the  United  States. 

In  India,  it  is  said  to  attain  the  height  of  fifteen 
or  twenty  feet ; but  in  this  country  it  does  not 
exceed  a few  feet.  The  seeds  ripen  succes-  Ricinus  communis, 
sively  in  August  and  September.  They  are  of  an  oval  shape,  some- 
what compressed,  and  about  the  size  of  a small  bean.  Externally 
they  are  smooth  and  shining,  and  of  a pale  grey  colour,  marbled 
with  reddish-brown  spots  and  stripes.  In  their  general  appearance, 
they  have  been  likened  to  a tick,  whence  the  name  Ricinus.  The 
husk,  which  constitutes  24  per  cent,  of  the  seed,  is  chiefly  composed 
of  ligneous  fibre,  with  a little  gum,  resin,  and  extractive  matter. 
The  nucleus  or  kernel,  which  has  been  found  to  amount  to  69  per 
cent,  of  the  seed  when  dry,  contains  46.2  of  fixed  oil,  2.4  of  gum, 
0.5  of  soluble  albumen  and  20  of  coagulated  albumen.  The  fixed 
oil  is-  the  Oleum  Ricini. 

The  quantity  of  castor  oil  used  almost  exceeds  belief.  Of  490, 
558  lbs.  imported  into  England  in  1830,  441,267  lbs.,  according  to 
M’Culloch,  came  from  the  East  Indies  ; 39,408  lbs.  from  the  British 
Northern  Colonies  of  America  ; 5,139  lbs.  from  the  United  Slates  ; 
and  4,718  lbs.  from  the  British  West  Indies.  A large  proportion  of 
that  used  to  the  east  of  the  Alleghanies  comes  by  way  of  New  Or- 
leans from  Illinois  and  the  neighbouring  States,  where  it  is  so  abun- 
dant as  to  be  sometimes  burnt  in  lamps.  (Wood  & Bache). 

The  mode  in  which  castor  oil  is  prepared  in  this  country  is  as  fol- 
lows; — The  seeds,  being  cleansed  from  all  extraneous  matters,  are 
put  into  a shallow  iron  reservoir,  and  submitted  to  a gentle  heat,  not 
greater  than  can  be  readily  borne  by  the  hand  ; the  object  of  which 
is,  to  render  the  oil  sufficiently  liquid  to  be  easily  expressed.  They 
are  then  introduced  into  a powerful  screw-press,  by  which  process  a 
whitish  oily  liquid  is  obtained,  which  is  transferred  to  clean  iron 
boilers,  supplied  with  a considerable  quantity  of  water.  The  mix- 
ture is  boiled  for  some  time,  and  the  impurities  being  skimmed  off,  a 
clear  oil  is  left  on  the  top  of  the  water,  the  mucilage  and  starch  being 
dissolved  in  the  water,  and  the  albumen  coagulated.  The  clear  oil 
is  removed,  and  the  process  completed  by  boiling  it  with  a small  pro- 
portion of  water,  continuing  the  application  of  heat  till  aqueous 
vapour  ceases  to  rise,  and  till  a small  portion  of  the  liquid,  taken  out 
in  a vial,  is  perfectly  transparent  when  it  cools.  The  effect  of  this 
last  operation  is  said  to  be  — to  clarify  it,  and  render  it  less  irritating 
by  driving  off  the  acrid  volatile  matter.  If  the  heat  be  carried  too 


1G4 


SPECIAL  CATHARTICS. 


far,  the  oil  acquires  a brownish  hue,  and  an  acrid  taste,  similar  to 
the  West  India  oil.  One  bushel  of  good  seeds  yields  five  or  six 
quarts,  or  about  25  per  cent,  of  the  best  oil.  (Wood  & Bache). 

Castor  oil,  which  is  obtained  by  expression  without  heat,  is  called 
cold-drawn  castor  oil. 

Recently  prepared  castor  oil,  or  oil,  as  it  is  often  called,  is  inodor- 
ous and  nearly  insipid  ; colourless,  or  of  a pale  straw  colour;  thick, 
but  perfectly  transparent.  It  is  lighter  than  water ; grows  rancid  by 
keeping;  thickens,  and  its  colour  becomes  of  a reddish-brown.  It 
has  a hot  nauseous  taste  ; is  completely  soluble  in  absolute  alcohol, 
and  in  pure  sulphuric  ether,  differing,  in  this  respect,  from  all  the 
ordinary  fixed  oils,  except  palm  oil.  Hence,  alcohol  is  recommended 
in  the  Edinburgh  Pharmacopoeia  to  test  its  purity.  In  this  country, 
however,  the  oil  is  so  common,  that  there  is  no  inducement  to  adul- 
terate it.  It  has  often  been  examined  by  the  chemist,  but  the  source 
of  its  cathartic  powers  has  not  been  discovered. 

Castor  oil  seeds  are  possessed  of  acrid  cathartic  properties,  and 
are  said  to  have  proved  fatal  when  taken  to  the  extent  of  20  at  once. 
The  acrid  principle  is  considered  to  be  dissipated  by  the  heat  of 
boiling  water ; but  it  is  more  probable  that  it  exists  in  the  covering 
of  the  kernal,  inasmuch  as  the  cold-drawn  castor  oil  does  not  appear 
to  be  more  active  than  that  which  is  prepared  by  heat.  It  has  been 
seen,  indeed,  that  long  continued  heat  developes  acridity. 

Castor  oil  is  one  of  the  most  valuable  of  the  mild  cathartics,  ope- 
rating by  virtue  of  a special  affinity  for  the  mucous  membrane  of  the 
bowels  ; for  when  injected  into  the  veins  — as  was  done  by  a respect- 
able physician  of  this  country,  (page  137),  it  produced  griping  and 
purging,  and  what  was  more  surprising,  the  taste  of  castor  oil  was 
experienced.  It  is  one  of  the  most  speedy  in  its  operation,  and,  ac- 
cordingly, is  well  adapted  for  all  cases  in  which  it  is  desirable  to 
evacuate  rapidly  the  contents  of  the  bowels.  It  is  apt,  however,  to 
induce  nausea  and  vomiting,  and  this  sometimes  renders  it  inappli- 
cable. 

As  elsewhere  remarked,  its  cathartic  action  is  not  by  any  means  in 
a ratio  with  the  dose  ; hence,  in  cases  in  which  it  is  merely  desirous 
to  evacuate  gently  the  bowels,  a tea-spoonful  or  two  will  often  operate 
as  effectually  as  a larger  quantity,  and,  of  course,  with  less  proba- 
bility of  exciting  nausea.  The  author  is  constantly  in  the  habit  of 
giving  it  in  tea-spoonful  doses,  especially  where  there  is  erethism  of 
the  mucous  membrane  of  the  bowels,  and  the  dose  is  generally  suffi- 
cient. For  children,  it  is  unquestionably  one  of  our  most  satisfactory 
cathartics,  and  is  in  constant  use  in  domestic  practice,  — the  only  ob- 
jection being  its  nauseous  taste. 

The  ordinary  dose  of  castor  oil  is  considered  to  be  a fluidounce, 
or  about  two  table-spoonfuls  ; rarely,  however,  can  more  than  a table- 
spoonful be  needed.  For  children,  the  ordinary  dose  is  a tea-spoonful. 
It  is  so  exceedingly  disagreeable  to  many  persons,  that  they  can 
scarcely  be  prevailed  upon  to  take  it  ; and,  under  such  circumstances, 
if  it  reaches  the  stomach,  it  is  apt  to  be  rejected.  As  in  other  cases, 


RHEUM/ 


165 


however,  if  the  dose  be  repeated  immediately,  it  may  be  retained. 
To  obviate  its  unpleasant  taste,  it  may  be  dropped  on  a little  aromatic 
water,  spirit  and  water,  hot  coffee,  or  hot  milk,  and  the  mouth  may 
be  rinsed  with  some  of  the  vehicle  before  it  is  swallowed.  Dr.  R. 
E.  Griffith,  of  Philadelphia,  says  the  most  effectual  mode  of  dis- 
guising its  taste  is  to  mix  it  with  the  froth  of  porter.  It  is  not  un- 
frequently  made  into  an  emulsion  with  the  yolk  of  egg  or  mucilage 
and  some  aromatic  water.  ( 01.  ricinij  f.5vj  ; vitell.  ovij  seu  mucilag. 
acac.  f.5ss  ; aqucE  mentlm  pip.  f.^v.  — Dose,  a fourth  part  every  two 
hours  until  it  operates.  Oil  of  turpentine  aids  its  action  materially, 
but  renders  it  still  more  disagreeable.  Should  it  be  indicated,  two 
drachms  may  be  added  to  the  above  mixture.  Where  nausea  and 
vomiting  are  anticipated,  or  intestinal  irritation  exists  at  the  same 
time,  ten  drops  of  laudanum  may  be  added  to  the  dose  of  oil. 

RHEUM— RHUBARB. 

Rhubarb  is  the  root  of  Rheum  palma'tum.,  and  other  species  of 
Rheum  ; Sex.  Syst.  Enneandria  Monogynia ; Nat.  Ord.  Poly- 
gonacese.  The  botanical  history  of  this  drug,  long  and  extensively 
as  it  has  been  known  and  employed,  is  still  unsettled.  Different 
varieties  have  been  referred  to  different  species  of  rheum  diffused 
over  the  Asiatic  continent,  yet  still  its  pharmacological  history  is  un- 
determined. 


Fig  13.  Fig  14. 


Kheutn  Palmatiim.  Rheum  Coinpactum. 


The  chief  varieties  of  rhubarb  root  met  with  in  commerce  are  the 
Chinese^  Russian^  and  the  European.  Dr.  Pereira,  however,  states, 
that  he  is  acquainted  with  six  kinds  — the  Russian.,  the  Dutch-trim- 
med., the  Chinese^  the  Himalaya7i,  the  English.,  and  the  French. 

The  Chinese,  or  East  India  Rhubarb,  constitutes  the  largest  por- 
tion of  that  which  is  used  in  this  country.  It  is  brought  either  directly 
from  Canton,  or  by  Singapore  and  other  ports  of  the  East  Indies.  As 


166 


SPECIAL  CATHARTICS. 


we  meet  with  it,  it  is  either  in  round  or  flattened  pieces  ; seems 
smooth,  as  if  it  had  been  scraped  ; and  is  generally  perforated  with 
holes,  in  many  of  which  are  found  pieces  of  the  cords  by  which  they 
had  been  suspended.  It  is  more  heavy  and  compact  than  the  Rus- 
sian variety  ; the  smell,  too,  is  much  less  powerful,  and  the  colour  of 
the  powder  of  a more  dull  yellow  or  brownish  cast. 

The  Russian,  Turkey,  Moscow,  Bucha'rian  or  Sibe'rian  Rhubarb, 
is  imported  from  St.  Petersburg  ; and  is  said  to  have  been  formerly 
shipped  from  the  Turkish  ports,  to  which  it  was  brought  from  Tar- 
tary, by  caravans,  through  Persia  and  Natolia.  Hence,  it  was  often 
called  Turkey  Rhubarb.  The  Bucharian  merchants  have  entered  into 
a contract  with  the  Russian  government  to  supply  it  with  rhubarb  in 
exchange  for  furs.  It  is  carried  by  them  to  Kiachta,  a frontier  town, 
where  it  is  inspected  by  a Russian  apothecary,  employed  there  for 
the  purpose.  The  worm-eaten  portions  are  rejected,  and  the  others 
are  bored  to  ascertain  their  soundness.  The  portions  which  do  not 
pass  examination  are  burned,  and  the  rest  is  sent  on  to  the  Russian 
capitol. 

The  size  and  shape  of  the  pieces  are  various,  — the  external  appear- 
ance seeming  to  show,  that  the  cortical  portion  had  not  been  scraped 
as  in  the  Chinese  Rhubarb,  but  had  been  cut  off  longitudinally  by 
the  knife  ; hence  the  angular  appearance  of  the  surface.  The  smell 
and  taste  are  essentially  those  of  the  Chinese  variety,  excepting  that 
it  is  somewhat  more  aromatic.  The  aroma  is  considered,  however, 
to  be  so  delicate,  that,  according  to  Dr.  Pereira,  in  all  wholesale  drug 
houses,  a pair  of  gloves  is  kept  in  the  Russian  rhubarb  drawer  with 
which  to  handle  the  pieces.  When  chewed,  both  it  and  the  Chinese 
variety  feel  gritty  under  the  teeth,  owing  to  the  presence  of  numerous 
crystals  of  oxalate  of  lime.  The  colour  of  the  powder  is  a bright 
yellow,  without  the  orange  tinge  of  the  Chinese. 

As  the  Russian  is  much  more  expensive  than  the  Chinese  variety, 
the  latter  is  sometimes  cut  so  as  to  resemble  it ; but  the  fraud  may 
be  detected  by  attention.  Dr.  Wood  states,  that  he  has  seen  parcels 
of  very  good  rhubarb  imported  from  Canton,  which  were  evidently 
prepared  so  as  to  resemble  the  Russian  ; but  in  most,  if  not  ail,  of 
the  pieces  which  came  under  his  notice,  the  small  perforating  hole 
was  found,  which  characterises  the  Chinese  rhubarb,  although  in  some 
instances  it  had  been  filled  with  the  powdered  root  so  as  to  conceal 
it.  This  was  probably  the  Dutch-trimmed,  or  Bata'vian  Rhubarb, 
which,  according  to  Dr.  Pereira,  is  imported  from  Canton  and  Singa- 
pore. Sometimes  the  worm-eaten  pieces  are  made  to  resemble  the 
sound  by  filling  up  the  holes  with  a mixture  of  powdered  rhubarb 
and  mucilage,  and  covering  over  the  surface  with  the  powder  ; but, 
by  removing  this,  the  fraud  is  detected. 

At  times,  too.  the  eastern  varieties  are  mixed  with  the  European  ; 
the  last  of  which  is  easily  distinguishable  by  its  weaker  aroma,  and 
want  of  grittiness  when  chewed.  It  is  not  easy,  however,  to  detect 
the  admixture,  if  the  rhubarb  be  in  a state  of  powder,  and  the  adul- 
terating article  be  in  small  quantity. 


RHEUM. 


167 


The  Europf/an  Rhubarb  is  much  inferior  to  that  which  is  brought 
from  Russia  and  China.  In  England  two  kinds  are  met  with  in  the 
shops  under  the  name  of  English  Rhubarb,  one  dressed  or  trimmed^ 
so  as  to  resemble  the  Russian ; the  other,  sometimes  called  stick 
rhubarb.  It  is  raised  in  various  parts  of  England,  but  chiefly  near 
Banbury  in  Oxfordshire,  and  is  distinguished  from  the  Asiatic  varie- 
ties by  being  externally  of  a reddish  hue,  and  having  brownish  spots 
of  adhering  bark,  and  internally  a looser,  softer,  spongy  texture,  with 
occasional  cavities,  especially  in  the  centre.  It  is  pasty  under  the 
pestle.  In  taste  and  smell,  it  resembles  the  Asiatic  rhubarb  ; but  is 
more  mucilaginous,  and  does  not,  like  it,  feel  gritty  under  the 
teeth.  The  stick  rhubarb  is  in  irregular  pieces,  about  five  or  six 
inches  long,  and  an  inch  thick.  Its  taste  is  astringent,  but  very  mu- 
cilaginous. Both  varieties  of  English  rhubarb  are  said  to  be  exten- 
sively employed  by  druggists  to  adulterate  the  powder  of  Asiatic 
rhubarb. 

Rhubarb  is  likewise  cultivated  largely  in  France,  especially  at  an 
establishment  called  Rheurnpole,  near  the  port  of  Lorient. 

The  quantity  of  rhubarb  consumed  is  very  great.  In  the  year 
1831,  according  to  McCulloch,  there  were  imported  into  England 
from  Russia  6,901  lbs.;  from  the  East  Indies,  133,462  lbs.  : of  this 
quantity,  40,124  lbs.  were  retained  for  home  consumption. 

The  medical  virtues  of  rhubarb  are  yielded  wholly  to  water  and 
to  alcohol.  It  has  been  repeatedly  subjected  to  chemical  analysis, 
but  the  results  have  not  been  of  much  pharmacological  interest. 
T'hey  show  that  it  contains,  along  with  its  cathartic  constituents,  a 
bitter  principle,  and  astringent  matter,  consisting  of  tannic  and  gallic 
acids,  to  which  a portion  of  its  medical  virtues  is  referable. 

Rhubarb  is  one  of  the  most  valuable  cathartics,  seeming  to  act 
upon  the  whole  tract  of  the  intestines,  and  not  causing  any  very 
copious  secretion  from  the  lining  membrane.  It  is,  consequently, 
one  of  the  mildest  of  the  class.  Owing  to  its  containing  tannic  and 
gallic  acids,  it  is  somewhat  astringent,  and  the  common  opinion  is, 
that  it  is  first  an  evacuant  to  the  bowels,  and  afterwards  an  astrin- 
gent. Its  bitter  principle,  too,  gives  it  tonic  properties,  and  hence, 
in  small  doses  it  is  prescribed  whenever  a joint  tonic  and  laxative 
agency  is  needed.  Like  many  other  cathartics,  its  action  is  often 
accompanied  by  tormina,  which  may  be  obviated  by  the  addition  of 
some  aromatic. 

Associated  with  other  cathartics  it  forms  one  of  the  most  common 
prescriptions  of  the  physician.  It  is  often  given,  especially  in  in- 
fancy, combined  with  magnesia  or  its  carbonate,  which  is  said  to  re- 
move the  constipating  influence,  that  rhubarb,  given  alone,  exerts 
after  it  has  acted  as  a cathartic.  United  with  the  mild  chloride  of 
mercury,  and  an  appropriate  corrigent,  it  is  an  active  cathartic,  and 
one  very  commonly  prescribed.  [Pulv.  rhei  gr.  xv.  ; hydrarg.  chlo~ 
rid.  mit..,pulD.  zingib.  aa  gr.  v.  M. 

By  roasting  rhubarb,  its  cathartic  power  is  diminished,  and  its  as- 


168 


SPECIAL  CATHARTICS. 


tringency  — it  has  been  supposed  — increased  ; hence,  it  is  not  un- 
frequently  employed  in  diarrhoea  and  dysentery. 

The  dose  of  rhubarb,  to  produce  a full  operation,  is  from  twenty 
to  thirty  grains  ; in  smaller  doses,  it  acts  as  a laxative,  d'he  Euro- 
pean varieties  require  to  be  given  in  twice  the  quantity.  Its  nausea 
and  bitter  taste,  according  to  Dr.  A.  T.  Thomson,  is  completely  co- 
vered, when  mixed  with  milk,  if  the  mixture  be  taken  directly  ; but 
if  not  taken  immediately  the  medicine  soon  communicates  its  taste 
to  the  milk. 

When  not  given  in  this  form,  one  of  the  following  officinal  pre- 
parations may  be  prescribed  : 

uwmi  RnEI,  INFU'SION  OF  RIIFBARB.  cont.  5j.  ; Aquce  hullient 

Oss.)  The  dose  of  this  infusion,  as  a laxative,  is  f.  |j.  or  f.  ^ij. ; 
but  it  is  rarely  given  alone.  It  is  commonly  used  as  a vehicle  for 
other  cathartics  or  tonics,  or  for  magnesia,  when  used  as  an  antacid. 

PlLTlil  RllFI,  PILLS  OF  RHUBARB.  {Rhei,  in  pulv.  5ij.  ; sapon.  5ij.  ; di- 
vide in  pil.  cxx.)  Generally  taken  at  bedtime  as  a laxative.  Dose, 
two  or  three,  repeated  on  the  following  morning  if  necessary. 

PILTILT  RIIFI  COMPOSHTiE,  COIPOIAD  PILLS  OF  RHUBARB.  [Rhei, 
pulv.  5j.;  Aloes^  pulv.  Jvj.  ; Myrrh,  pulv.  ,^ss. ; ol.  menth.  piperit: 
f.  5ss.  ; Syrup,  aurant.  q.  s.  ut  fiant  pil.  cclx.)  The  aloes  adds  to 
the  activity  of  the  rhubarb  ; but  it  is  not  easy  to  see  what  can  be  the 
effect  of  the  myrrh  ; the  oil  of  peppermint  is  a corrigent,  which  pre- 
vents the  cathartics  from  griping.  It  is  a good  laxative  pill,  in  the 
dose  of  two  to  four  taken  at  bedtime. 

SYR'IIPUS  RIIFI,  SYRUP  OF  RHUBARB.  {Rhei  contus.  gij.;  Agues  bid- 
lient.  Oj.  ; Sacchar.  fbij.  made  into  a syrup.)  Given  in  the  dose  of 
a teaspoonful  or  two  to  infants  as  a laxatiA^e.  It  is  not  so  frequently 
administered,  however,  as  the  following  : 

SYRUPUS  RIIFI  AROMAT'ICUS,  AROMATIC  SYRUT  OF  RHUBARB.  {Rhei,  con- 
tus. ^iiss.  ; Caryophyll.  contus.  Cinnam.  contus.  aa  ,^ss.;  Myristic. 
cont.  5ij.  ; Alcohol,  dilut.  Oij.  ; Syrup.  Ovj.  made  into  a syrup.  It 
may  be  prepared  also  by  the  process  of  displacement.  See  the  Phar- 
macopoeia of  the  United  States,  1842.)  This  is  much  used  in  do- 
mestic practice,  under  the  name  of  spiced  syrup  of  rhubarb,  in  the 
bowel  affections  of  children,  especially  in  those  that  occur  during 
the  summer  and  autumnal  months.  The  aromatics  and  the  alcohol 
impart  excitant  properties  to  it,  and  render  it  carminative  and  laxa- 
tive. The  dose  for  an  infant  is  a teaspoonful  or  two. 

TIYCTU'RA  RIIFI,  TINCTURE  OF  RHUBARB.  {Rhei,  cont.  5iij.;  Cardam. 
cont.  5ss.  ; Alcohol,  dilut.  Oij.  It  may  be  prepared  also  by  the  pro- 
cess of  displacement.)  The  cardamoms  are  added  as  a corrigent. 


ALOE. 


169 


In  the  dose  of  f.  §ss.  to  f.  §j.  it  proves  cathartic.  In  lesser  doses,  it 
is  sometimes  taken  as  a stomachic  and  laxative. 

TINCTU'RA  RlIEI  ET  ALOES,  TINCTURE  OF  RHUBARB  AND  ALOES.  [Rhei,  cont. 

; Aloes^  pulv.  ^vj.;  Cardam.  cont.  §ss.  ; Alcohol,  dilut.  Oij.) 
This  is  the  relic  of  the  ancient  Elixir  sacrum.  It  combines  the  ca- 
thartic virtues  of  both  rhubarb  and  aloes.  The  dose,  as  a cathartic, 
is  from  f.  ^ss.  to  f.  §j. 

TINCTU'RA  RHEl  ET  GENTIAM,  TINCTURE  OF  RHUBARB  AND  GENTIAN. 
{Rheij  cont.  ^ij  ; Gentian,  cont.  gss. ; Alcohol,  dilut.  Oij.  It  may 
also  be  made  by  the  process  of  displacement.)  By  combining  the 
tonic  virtues  of  the  gentian,  this  tincture  is  employed  as  a tonic  and 
laxative,  in  doses  of  from  f.  3i.  to  f.  §ss. ; in  larger  doses,  f.  ^i.  to 
f.  §ij.  it  is  cathartic. 

TINCTU'RA  RHEI  ET  SENNTl,  TINCTURE  OF  RHUBARB  AND  SENNA.  {Rhei, 
cont.  ; Sennce.,  gij  ; Coriandr.  cont. ; Fmdcul.  cont.  aa  ; Santal. 
rasur.  gij  ; Croci,  Glycyrrhiz.  aa  ^ss  ; Uvar  passar.  demptis  acinis, 
|-{3ss ; Alcohol,  dilut.  Oiij.)  This  polypharmacal  production  is  an 
imitation  of  WarneEs  Gout  Cordial.  The  rhubarb  and  senna  are 
cathartics  ; the  coriander  and  fennelseed  excitants,  and  therefore  cor- 
rigents  ; the  red  saunders  and  saffron  are  mere  colouring  matters  ; 
the  liquorice  and  raisins  communicate  sweetness  to  the  tincture.  It 
is  an  agreeable  stomachic  and  laxative,  especially  in  the  flatulence 
of  the  gouty,  and  such  as  have  been  addicted  to  the  use  of  wine  or 
spirituous  liquors.  The  dose  is  f.  gss.  to  f.  5ij. 

VINUM  RHEI,  WINE  OF  RHUBARB.  (Me^,  contus.  gij  ; Canellse^  contus. 

\ Alcohol,  dilut.  f.  ^ij  ; Vini^  Oj.)  Canella  is  an  excitant  and  corri- 
gent ; and  the  wine  is  applicable  to  the  same  cases  as  the  Tinctura 
Rhei.  The  dose  is  from  f.  5iij.  to  f.  |j. 

13.  ALOE.— AL'OES. 

Aloes  is  the  inspissated  juice  of  the  leaves  of  Al'oe  spica'ta.,  and 
other  species  of  aloe ; Sex.  Syst.  Hexandria 
Monogynia ; Nat.  Order,  Liliacese.  The  Lon- 
don Pharmacopoeia  refers  it  to  Aloe  spicata 
alone  ; the  United  States  Pharmacopoeia  (1842), 
with  more  propriety,  to  that  as  well  as  other  spe- 
cies. It  is  generally  believed,  indeed,  that 
three  species  furnish  the  different  kinds  in  the 
market, — Aloe  spica'ta^A.  vulga'ris^  and.^.  Soco- 
torUna.,  and  it  is  considered  probable,  that  at  least 
two  other  species  are  employed,  — A.  Com- 
meli'ni  of  Willdenow,  and  A.  linguseform'is  of 
Thunberg. 

The  information,  which  we  possess  as  to  the 
sources  of  aloes,  is  still  unprecise.  Within  a few 
years,  the  drug  has  been  imported  into  England  from  Bombay, 
VOL.  I.  — 15 


Fig.  15. 


Aloe  Socotorina. 


170 


SPECIAL  CATHARTICS. 


Arabia,  Socotora,  Madagascar,  the  Cape  of  Good  Hope,  the  Le- 
vant, and  the  West  Indies,  and  it  would  seem,  that  the  aloes  of 
British  commerce  is  derived  more  or  less  from  most,  if  not  all  of 
these  places,  directly  or  indirectly. 

The  finest  aloes  is  obtained  by  inspissating  the  juice,  which  flows 
spontaneously  from  transverse  incisions  made  in  the  leaves.  If 
pressure  be  used,  the  juice  becomes  mixed  with  the  mucilaginous 
liquids  of  the  leaves,  and  an  inferior  kind  of  aloes  is  the  result.  A 
still  inferior  kind  is  prepared  by  boiling  the  leaves,  after  the  juice 
has  escaped,  in  water. 

In  England,  no  less  than  seven  varieties  of  aloes  are  met  with — the 
Soc'otrine,  Hepat'iCj  Barba' does,  Cape,  Mocha,  Cah'alline,  and  In’dian, 
(Pereira.)  In  this  country,  we  rarely  see  more  than  three,  the  •S'o- 
cotrine,  the  Cape  of  Good  Hope,  and  the  Hepatic.  (Wood  and  Bache.) 

SocoTRiNE  Aloes  ought  to  be  obtained  from  the  Island  of  Soco- 
tora, in  the  Straits  of  Babelmandeb,  but  much  that  is  sold  under  that 
name  is  procured  from  other  places.  It  would  appear  that  in  1833 
the  quantity  exported  from  that  island  was  two  tons. 

The  name  Socotrine  Aloes  is  often  given  to  the  best  specimens  of 
aloes,  no  matter  whence  obtained.  Both  in  Spain  and  the  West 
Indies,  according  to  Wood  and  Bache,  the  juice,  inspissated  in  the 
sun,  bears  this  name.  It  would  appear,  however,  that  the  commer- 
cial value  of  the  real  Socotrine  aloes  is  now  below  that  of  Barbadoes 
aloes,  than  which  it  is  perhaps  inferior  in  activity. 

Socotrine  aloes  is  of  a yellowdsh  or  reddish-brown  colour,  which 
becomes  deepened  by  exposure  to  air.  The  fracture  is  smooth,  glassy, 
conchoidal ; yet,  even  when  of  excellent  quality,  it  often  breaks 
with  a roughish  fracture.  The  powder  is  of  a golden  yellow  colour. 
The  odour  of  fresh  broken  pieces,  especially  when  breathed  on,  is 
fragrant  according  to  some  ; it  is  certainly  peculiar,  and  perhaps,  to 
the  mass,  not  unpleasant.  The  taste,  like  that  of  all  the  aloes,  is  in- 
tensely and  enduringly  bitter,  but  perhaps  it  is  somewhat  less  disa- 
greeable than  the  other  varieties. 

Cape  of  Good  Hope  or  Cape  Aloes,  is  imported,  as  its  name 
shows,  from  the  Cape  of  Good  Hope  into  Great  Britain,  whence  it  is 
again  imported  into  the  United  States,  and  is  the  variety  chiefly  used 
in  this  country.  It  differs  materially  in  its  appearance  from  the  So- 
cotrine aloes,  having  a shining  resinous  aspect,  whence  its  name  of 
Hl'oe  lidcida  with  the  Germans.  It  is  of  a deep-brown  colour,  ap- 
proaching to  black,  and  has  a glossy  or  resinous  fracture.  When 
held  up  to  the  light  its  edges  appear  translucent,  and  have  a yel- 
lowish-red or  ruby  colour.  The  powder  is  of  a greenish-yellow  colour. 
Its  odour  is  stronger  and  more  disagreeable  than  that  of  the  preced- 
ing variety. 

Hepatic  or  Barbadoes  Aloes  is  imported  from  Barbadoes  or 
Jamaica  in  gourds.  Its  colour  varies  from  a dark-brown  or  black  to 


ALOE. 


171 


a reddish-brown  or  liver  colour.  The  fracture  is  sometimes  dull ; at 
others,  glossy.  The  powder  is  of  a dull  olive-yellow  colour.  The 
odour,  especially  when  breathed  upon,  is  exceedingly  disagreeable 
and  nauseous.  It  is  known  that  this  variety  is  obtained  from  the 
AVoe  vulga'ris.  It  is  but  little  used  in  this  country,  except  for  horses. 

A variety  of  aloes,  called  Genuine  Hepatic  Aloes,  Liver-co- 
loured SocoTRiNE  Aloes,  is  exported  from  Bombay,  and  would 
appear  to  be  an  inferior  variety  of  the  Socotrine.  The  two  are 
sometimes,  indeed,  intermixed. 

The  composition  of  aloes  has  been  investigated  by  many  distin- 
guished chemists,  Trommsdorff,  Bouillon-Lagrange,  Vogel,  Bracon- 
not,  and  Winkler.  It  was  for  a considerable  period  regarded  as  a 
gum-resin,  but  it  is  questionable,  whether  it  contain  strictly  either 
gum  or  resin.  Its  most  important  constituent  is  a bitter  extractive 
matter,  termed  aloesin^  which,  according  to  Trommsdorff,  forms  75 
per  cent,  of  Socotrine  aloes,  and  81.25  of  Barbadoes  aloes.  Some 
specimens  of  the  latter  did  not,  however,  contain  more  than  52  per 
cent.  There  is,  in  addition  to  this,  a resinoid  substance,  the  pro- 
portion of  which  varies  from  6.25  to  42  per  cent. — which  has  be.en 
considered  oxidised  extractive. 

The  most  important  point,  in  a pharmacological  point  of  view,  is, 
that  aloes  yields  its  medical  virtues  to  cold  water ; a dark-brown 
substance,  however,  being  left,  which  is  dissolved  by  boiling  water, 
but  is  deposited  again  as  the  water  cools.  This  is  the  resinoid  sub- 
stance. Its  best  solvent  is  dilute  alcohol. 

Aloes  is  more  extensively  used  than  any  other  vegetable  cathartic. 
It  forms  the  basis  of  most  cathartic  pills.  Its  action  appears  to  be 
exerted  on  every  portion  of  the  canal,  but  especially  on  the  large 
intestines.  Even  when  placed  in  contact  with  an  abraded  surface, 
it  exerts  its  wonted  effect  on  the  bowels  ; affording  an  example  of 
that  special  affinity  between  particular  therapeutical  agents  and  par- 
ticular portions  of  the  economy  of  which  we  have  so  many  exam- 
ples. In  large  doses  it  is  apt  to  irritate  the  rectum,  and  is  therefore 
improper  for  those  who  are  suffering  under  piles,  and  in  pregnancy. 
When,  however,  it  is  associated  with  hyoscyamus,  its  injurious 
agency,  in  the  latter  condition  especially,  is  obviated.  {Aloes 
pulv.  ; Ext.  hyoscyam.  9j. — M.  et  divide  in  pilulas  xx. — Dose, 
two  at  bedtime.) 

In  its  operation,  aloes  does  not  stimulate  greatly  the  cutaneous 
exhalants,  and  hence  the  evacuations  are  not  as  watery  as  those  pro- 
duced by  many  other  cathartics.  It  is  rarely,  however,  given  alone; 
being  usually  associated  with  other  cathartics,  and  with  some  essen- 
tial oil  or  other  excitant,  to  prevent  the  griping,  which  it  is  so  apt  to 
occasion.  It  is  affirmed,  too,  that  certain  substances,  although  not  pos- 
sessed of  any  cathartic  property,  increase  the  cathartic  action  of  aloes. 
Several  vegetable  bitters,  especially  sulphate  of  quinia,  and  likewise 
sulphate  of  iron,  have  been  considered  to  act  in  this  manner.  Dr. 


172 


SPECIAL  CATHARTICS. 


Christison  states,  that  he  has  not  been  able  to  remark  the  property  in 
sulphate  of  quinia,  but  that  it  is  undoubtedly  possessed  by  sulphate 
of  iron, — one  grain  of  aloes  with  two  or  three  grains  of  that  salt 
producing  as  much  effect  as  two  or  three  grains  of  aloes  alone,  and 
with  much  less  tendency  to  irritate  the  rectum.  The  attention  of 
the  author  has  been  drawn  to  this  point,  but  he  has  not  been  able  to 
speak  so  positively  as  Dr.  Christison.  It  can  be  understood,  how- 
ever, that  any  tonic  combined  with  a laxative  may  have  the  effect 
of  aiding  the  operation  of  the  latter,  by  the  greater  energy  it  com- 
municates to  the  digestive  operations. 

The  bitter  extractive  of  aloes  renders  it  at  the  same  time  tonic, 
and  hence  its  usual  association  in  “ dinner  pills”  with  tonics,  where 
it  is  advisable  to  have  a joint  tonic  and  laxative  action. 

Aloes  is  rarely  given  where  a speedy  action  on  the  canal  is  needed. 
Its  operation  is  gradual,  and  hence,  as  well  as  by  reason  of  its  ex- 
ceedingly nauseous  taste,  it  is  generally  given  in  the  form  of  pill. 
Its  action  is  by  no  means  in  proportion  to  the  dose  ; and,  accordingly, 
it  may  be  prescribed  with  impunity  even  to  children  in  very  large 
doses.  The  author  w^as  first  induced  to  employ  aloes  so  largely 
from  the  very  high  eulogiums  he  had  heard  pronounced  upon  it  by 
Dr.  Hamilton,  late  Professor  of  Midwifery  in  the  University  of  Edin- 
burgh, to  whom  the  idea  of  administering  it  freely  in  diseases  of 
children  was  suggested  by  observing,  in  an  apothecary’s  shop, 
where  he  had  been  placed  by  his  father  for  the  purpose  of  being 
practically  instructed  in  Pharmacy,  that  the  Syrup  of  buckthorn — so 
called  — which  they  were  in  the  habit  of  vending  to  mothers  ot 
families  to  be  given  to  their  children,  was  usually  formed  extempo- 
raneously of  aloes  dissolved  in  treacle  or  molasses  ; and  upon  making 
inquiries  of  those  who  had  purchased  it,  he  found  that  no  bad  effects 
had  resulted  from  its  administration ; he,  consequently,  formed  the 
determination  of  trying  it  in  his  own  practice,  when  he  found  it  to 
be  not  only  a successful  agent  after  other  means  had  failed,  but  also, 
that  it  was  rarely  rejected  by  the  stomach,  acted  mildly,  was  per- 
fectly safe,  and  but  seldom  objected  to  by  young  infants.  The  author 
has  elsewhere  detailed  cases  in  his  own  practice,  as  well  as  in  that 
of  others,  in  which  two  drachms  of  nowdered  aloes  were  taken  in 
this  form  in  two  successive  days,  without  any  griping  or  unpleasant 
symptom,  and  wdth  full  relief  to  the  constipation.  ( Commentaries  on 
Diseases  of  the  Stomach  and  Bowels  of  Children^  p.  92,  Lond.  1824.) 

The  dose  of  aloes,  as  a purgative,  is  from  five  to  ten  grains  or 
more ; as  a laxative,  two  or  three  grains  in  the  form  of  pill. 

PILTU  AUOiiS,  ALGET  IC  PELS {Mfes  pulv.,  Sapon.  aa  ^ij.  Divide 
in  pil.  ccxl.)  The  soap  is  added  with  the  view  of  assisting  the  solu- 
tion of  the  aloes,  so  as  to  cause  it  to  act  on  the  whole  intestinal  tract, 
rather  than  on  the  rectum.  Five  pills  contain  ten  grains  of  aloes  ; 
so  that  two  at  bedtime  will  usually  produce  a laxative  effect  on  the 
following  day. 


ALOE. 


173 


PILTLJl  ALOES  ET  ASSAFffl'TIDl,  PILLS  OF  AL'OES  AND  ASSAFETIDA.— 
pulv.,  Jlssafcetid.^  Saponis,  aa  Jss. ; divide  in  pilulas  clxxx.) 
The  assafetida  is  added  as  an  excitant ; and  the  piU  is  given  in 
constipation  accompanied  by  flatulence,  and  impaired  tone  of  the 
stomach  and  intestines.  Dose,  two  to  five. 

Ptt'UL^  AL'OES  ET  MYRRHiE,  PILLS  OF  AL'OES  AND  MYRRH.  — (Jiloes 
pulv.  Eij  ; Myrrh,  pulv.  gj  ; Croci,  ^ss  ; Syrup q.  s.  ut  fiant  pil. 
cccclxxx.)  These  are  the  old  PilulcB  Rufi  or  Rufuses  pills.  They 
are  frequently  used  by  females  labouring  under  catamenial  obstruc- 
tion, which  is  generally  attended  by  more  or  less  atony  and  consti- 
pation ; the  myrrh  being  regarded  as  an  emmenagogue.  The  dose  is 
from  three  to  six. 

PULVIS  AL'OES  ET  CANEL'LiE,  POWDER  OF  AL'OES  AND  CANELLA.  — (Moes, 
Ihj  ; CanellcB^  This  is  the  old  Hiera  pier  a or  “ holy  hitter 

which  has  long  been  much  used  in  domestic  practice  as  an  emmen- 
agogue. The  canella  is  excitant,  and  therefore  prevents  the  griping 
tendency  of  the  aloes ; but  like  the  last  preparation,  this  is  no  more 
emmenagogue  than  any  of  the  other  combinations  of  aloes ; all  of 
which  — as  elsewhere  remarked  — affect  the  uterus  only  by  contigu- 
ous sympathy,  through  their  action  on  the  lower  part  of  the  intesti- 
nal canal. 

TINCTU'RA  ALOES,  TINCTURE  OF  ALOES.  — pulv.  ; Glycyrrhiz. 
^iij  ; Alcohol.  Oss ; Aq.  destillat.  Oiss.)  The  same  objection  ap- 
plies to  the  tincture  of  aloes  as  to  the  powder,  and  indeed  to  every 
form  of  administration  except  the  pill.  It  is  in  the  highest  degree 
nauseous,  and  the  liquorice  renders  it  scarcely  less  so.  Its  dose,  as 
a cathartic,  is  from  f.  5SS.  to  f.  ^iss. 

TINCTU'RA  ALOES  ET  MYRRHS,  TINCTURE  OF  ALOES  AND  MYRRH.  {Aloes 
pulv.  §iij  ; Croci,  jj  ; Tinct.  Myrrh.  Oij.)  This  is  a relic  of  the 
Elixir  Proprietatis  of  Paracelsus.  It  possesses  the  same  medical 
properties  as  the  Pilulse  Aloes  et  Myrrhse,  — the  saffron  being  a 
mere  colouring  ingredient.  Its  dose  is  from  f.  5j.  to  f.  5ij.  or 
more. 

VINUM  ALOES,  WINE  OP  ALOES.  (Aloes  pulv.  5]  ; Car  dam.  cont., 
Zingib.  cont.  aa  ; Vini,  Oj.)  The  wine  of  aloes  is  used  in  the 
same  cases  as  the  tincture  ; — the  cardamom  and  ginger  acting  as 
corrigents. 

Aloes  likewise  enters  into  other  officinal  formulae,  as  the  Extrac- 
turn  Colocynthidis  compositum  ; the  Pilules  Rhei  composites^  the  Tinc^ 
tura  Benzoini  composita,  and  the  Tinctura  Rhei  et  Aloes  — which 
are  described  elsewhere. 

15* 


174 


SPECIAL  CATHARTICS. 


Fig.  16. 


Fig.  17. 


14.  SENNA. 

In  the  Pharmacopoeia  of  the  United  States  (1842),  Senna  is  defined 
to  be  ‘‘the  leaflets  of  Cassia  acutifo'lia  (Delile),  Cassia  ohova'ta 
(De  Candolle)  and  Cassia  elonga’ta  (Lemaire  Journ.  de  Pharm.,\ii. 
345.)” 

These  plants  belong,  in  the  Sexual  System,  to  Decandria  Mono- 
gynia  ; Nat.  Ord.  Leguminosee.  Confusion,  however,  still  exists  as 
to  the  precise  species  that  yield  the  senna  leaves  of  commerce. 

The  leaflets  of  Cas'sia  ohova'ta,  which  is  a native  of  Egypt, 

Nubia,  Syria,  In- 
dia, &c.,  and  has 
been  cultivated 
Italy,  Spain, 


in 

and  the  West  In- 
dies, are  said  to 
form  Alep'po, 
Senegal'  and 
Ital'ic  Senna, 
and  to  be  one  of 
the  constituents 
of  Alexandrian 
senna.  Those 
of  Cas’sia  acu- 
tifo'lia, which  is 
a native  of  Egypt, 
in  the  valleys  of 
the  desert  to  the  south  and  east  of  Assouan,  are  collected  by  the 
Arabs,  and  sold  to  the  merchants,  who  convey  it  to  Cairo.  This 
is  said  to  be  the  species  that  furnishes  the  Trip'oli  Senna,  and 
the  greater  part  of  the  variety,  known  in  commerce  under  the  name 
of  Alexan'drian  Senna.  Dr.  Pereira,  however,  refers  the  Tripoli 
senna,  which  he  thinks  he  has  detected  in  Alexandrian  senna,  to 
Cas’sia  Mthiop’ica,  which  grows  in  Nubia,  Fezzan  to  the  south  of 
Tripoli,  and  probably  in  Ethiopia. 

The  leaflets  of  Cassia  elongata,  which  grows  in  India,  are  said  to 
yield  the  Tinnevell'y  and  Mecca  Sennas. 

The  consumption  of  senna  is  considerable.  The  quantity  on 
which  duty  was  paid  in  England,  in  1838  and  1839  was,  according 
to  Dr.  Pereira,  as  follows  ; from  the  East  Indies,  in  1838,  72,576 
lbs.  ; in  1839,  110,409  lbs.  ; from  other  places,  in  1838,  69,538, 
lbs.  ; in  1839,  63,766  lbs.  The  Mediterranean  senna  is  brought 
chiefly  to  this  country  from  Marseilles  ; the  Indian  variety  comes 
either  from  Bombay  or  Calcutta,  — directly,  or  by  the  way  of  London, 
where  it  is  purchased  at  the  East  Indian  Company’s  sales.  (Wood 
& Bache.) 

The  varieties  that  are  brought  to  this  country  are  the  Alexandrian, 
the  Tripoli  and  the  Indian. 


Legume  and  leaflet  of  Acute  leaved 
Alexandrian  Senna. 


Legume  and  leaflet  of  C. 
obovata.  (Pereira ) 


SENNA. 


175 


Alexandrian  Senna  is  an  admixture  of  the  leaflets  of  the  species 
of  cassia  referred  to  in  the  Pharmacopceia  of  the  United  States.  It 
is  sold  by  compulsion  to  the  Egyptian  government,  who  resell  it. 
It  is  collected  in  Nubia  and  upper  Egypt,  and  is  sent  down  the 
Nile  to  the  great  depot  of  Boulak,  near  Cairo.  It  is  of  a greyish 
green  colour  ; of  a smell  somewhat  resembling  that  of  tea,  and  of  a 
viscid  taste.  It  has  a broken  appearance,  and  contains  various  ex- 
traneous matters,  which  are  separated  from  it,  — when  it  becomes 
what  is  termed  picked  Alexandrian  senna. 

Tripoli  Senna  resembles,  in  appearance,  the  Alexandrian,  than 
which  it  is  much  cheaper.  It  is  more  broken  up,  however;  and, 
although  very  active,  is  less  esteemed.  The  common  opinion  is, 
that  it  is  carried  to  Tripoli  in  caravans  from  Fezzan ; but,  under  the 
belief  that  the  leaflets  are  furnished  by  Cassia  acutifolia,  which  differ, 
however,  in  some  respects,  from  those  in  the  Alexandrian  senna,  and 
taking  into  consideration  the  greater  cheapness  of  the  Tripoli  senna, 
Dr.  Wood  is  of  opinion,  that  it  grows  upon  the  Mediterranean  coast 
of  Africa,  in  the  vicinity  of  Tripoli. 

Of  the  Indian  Senna,  there  are  two  varieties  ; 1,  the  Tinnevelly 
Senna,  or  the  finest  East  Indian  Senna,  which  is  cultivated  at  Tinne- 
velly in  the  southern  part  of  India.  It  is  a fine  unmixed  senna,  is 
extensively  employed,  and  brings  a good  price.  It  consists  of  large 
unbroken  leaflets,  of  a fine  green  colour, 
from  one  to  two  inches  or  more  long,  and 
•at  times  half  an  inch  broad  at  their  widest 
part.  2.  An  inferior  or  second  East  Indian 
senna,  the  Mecca  Senna,  or  Pike  Senna, 
which  is  cultivated  in  Arabia,  and  finds 
its  way  to  Bombay.  It  is  in  long  leaflets, 
narrower  than  those  of  Tinnevelly  senna, 
and  of  a yellowish  colour,  some  of  the 
leaflets  being  brownish  or  even  blackish, 
and  is  occasionally  mixed  with  pods,  and 
with  stalks  and  dust.  Different  adulter- 
ations of  senna  have  been  pointed  out  by 
pharmacological  writers,  but  they  do  not 
appear  to  apply  to  the  sennas  of  this 
country,  which  are  sufficiently  pure. 

Senna  yields  its  virtues  to  water  — 
warm  or  cold  ; and  to  alcohol  — pure  or 
dilute  alcohol  are  the  menstrua  employed 
It  has,  1,  an  odorous  principle  — volatile 
course  is  lost  by  boiling.  This  has  a nauseous  odour  and  taste  ; and 
appears  to  possess  some  cathartic  power,  — the  distilled  water  acting 
as  a mild  cathartic  : — 2,  a purgative  principle,  to  which  the  name 
cathartin  has  been  given,  three  grains  of  which  cause  nausea,  griping 
and  purging. 

The  active  principle  is  precipitated  by  infusion  of  galls,  and  pro- 


Fig.  18. 


a.  Legume,  b.  Leaflet.  (Royle.) 

dilute  ; hence  water  and 
in  officinal  preparations. 
oil  of  senna  — which  of 


176 


SPECIAL  CATHARTICS. 


bably  by  other  astringents,  as  well  as  by  a solution  of  subacetate  of 
lead  ; but  these  substances  could  scarcely  be  combined  in  the  same 
prescription. 

Senna  has  a special  affinity  for  the  lining  membrane  of  the  intes- 
tines ; for  its  infusion  proves  cathartic  when  injected  into  the  veins  ; 
and  the  infant  at  the  breast  is  purged  by  it,  after  the  mother  has  taken 
it ; hence  it  must  have  passed  into  the  circulation  of  the  latter.  It 
might,  therefore,  operate  both  by  direct  contact,  and  indirectly  through 
the  circulation.  It  is  a safe,  active,  and  rapid  cathartic  ; hence  its 
value,  alone,  or  associated  with  other  articles,  that  act  speedily,  where 
such  action  is  desirable.  The  objection  to  it  is  its  nauseous  taste, 
and  tendency  to  induce  vomiting,  and  especially  severe  griping. 
The  corrigents,  generally  used  to  obviate  these  objectionable  quali- 
ties, are  aromatics  and  saccharine  matters,  which  last  have  been  con- 
sidered the  best  of  all.  They  appear,  too,  to  be  modified  by  com- 
bining it  with  certain  other  cathartics.  Like  other  cathartics,  too, 
its  purgative  effect  seems  to  be  increased  by  a combination  with 
tonics,  yet  the  combination  is  rarely  necessary,  and  therefore  not 
often  made,  on  account  of  the  disagreeable  character  of  the  com- 
pound. 

Senna  is  rarely  given  in  powder,  partly  on  account  of  the  quantity 
necessary  to  produce  the  effect.  From  ^ss  to  5ij  is  the  average  dose. 
Black  tea  and  coffee  have  been  advised  to  cover  its  disagreeable 
flavour. 

INFU'SUM  mm,  BFFSION  OF  SENNA.  {SenncB,^!] ; Coriandr.  cont.  §j; 
Aquce  hullient.  Oj.)  The  coriander  is  added  as  a corrigent.  Senna 
tea  is  a common  domestic  remedy,  especially  as  a purgative  for 
children,  sweetened  with  sugar.  It  is  most  commonly,  however, 
used  as  a vehicle  for  other  cathartics,  of  the  saline  class,  especially. 
The  well  known  Haustus  niger  or  black  draughty  or  black  dose  — the 
terror  of  the  invalid,  by  reason  of  its  nauseous  character  — is  a com- 
pound of  this  nature.  It  may  be  made  as  follows  : — Inf  us.  Sennce, 
f.  Jv  ; aq.  cinnam.  f.  §j  ; manncE^  5iv  ; magnes.  sxilphat.  5vj.  Dose,  an 
ounce  and  a half  or  more.  The  dose  of  the  Jnfusum  Sennce  is 
f.  §iv. 

According  to  Dr.  A.  T.  Thomson,  the  disagreeable  taste  of  senna 
is  considerably  less  when  the  infusion  is  made  with  cold  water,  al- 
though it  does  not  lessen  the  activity  of  the  drug.  The  taste  of  the 
ordinary  infusion  of  senna  is  covered  by  the  addition  of  a few  grains 
of  cream  of  tartar,  or  by  admixture  with  black  tea. 

^ TINCTU'RA  SENNiE^ET  JALA'PiE,  TINCTURE  OF  SENNA  AND  JALAP.  [Senn^, 
5iij  jalap,  pulv.  ; coriandr.  cont.  ; carui^  cont.  aa  gss  ; cardamom. 
cont.  5ij  ; sacchar.  giv  ; alcohol,  dilut.  Oiij.  It  may  be  made,  also, 
by  the  process  of  displacement.)  This  is  one  form  of  the  old  eliocir 
salutis.  The  jalap  is  a cathartic  adjuvant  j and  the  aromatics,  sac- 


CASSIA  MARILANDICA. 


177 


charine  matter,  and  the  menstruum  itself  act  as  corrigents.  It  is  a 
carminative  cathartic,  and  is  employed  occasionally,  like  the  tinc- 
ture of  rhubarb,  in  costiveness  attended  with  flatulence,  especially  in 
persons  of  the  gouty  diathesis.  It  is  more  commonly  used,  however, 
as  an  adjunct  and  adjuvant  to  the  infusion  of  senna.  Its  dose,  as  a 
cathartic,  is  from  f.  gss  to  §j. 

SYR'UPUS  SEMI,  SYRUP  OF  SENNA.  {Senum,  |ij ; FcRnic.  cont.  §j ; 
aqu(R  hullient.  Oj  ; sacchar.  §xv.)  The  syrup  may  be  added  to  the 
infusion  of  senna,  as  an  adjuvant  and  corrigent.  It  is  well  adapted, 
also,  as  a cathartic  for  children.  Dose,  f.  5j  to  f.  ^iij. 


CONFEC'TIO  SEMJl,  CONFECTION  OF  SENNA.  {Sennce,  Sviij ; coriandr. 


Fig.  19. 


oiv ; glycyrrhiz.  cont. 
liij;  Fic.  tbj;  pulp, 
prun.;  pulp,  tarna- 
rind.;  pulp,  cassice 
Jistul.  aa  Ihss;  saC‘ 
char,  ibiiss ; aquce 
Oiv.  Make  into  an 
electuary.)  This  is 
one  of  the  forms  of 
the  lenitive  electuary ^ 
long  used  as  a laxa- 
tive, especially  in 
cases  of  pregnant  fe- 
males, in  affections  of 
the  rectum,  and  when- 
ever a gentle  effect 
on  the  bowels  is 
needed.  The  cori- 
ander and  the  sac- 
charine matters  act 
as  corrigents  to  the 
senna ; whilst  the 
liquorice, figs, prunes, 
tamarinds,  and  pulp 
of  cassia  are,  at  the 
same  time,  laxative. 
The  dose  is  from  ^ij 
to  5iv,  taken  at  bed- 
time. 


Senna  likewise  en- 
ters into  other  offi- 
cinal preparations,  as 
the  tinctura  rhei  et 
senncBy  and  syrupus  rhei  et  senncB  of  the  Pharmacopoeia  of  the  United 

States. 


Cassia  Marilandica. 


178 


SPECIAL  CATHARTICS. 


15.  CAS'SIA  MARILAN'DICA.  — AMER'ICAN  SENNA. 

This  is  an  indigenous  perennial  plant,  Sex.  Syst.  Decandria 
Monogynia;  Nat.  Ord.  Leguminosee,  from  three  to  six  feet  high, 
with  flowers  of  a beautiful  golden  yellow  colour,  which  is  very 
common  in  every  part  of  the  United  States  to  the  south  of  New 
York,  growing  most  abundantly  in  flat  ground  on  the  margins  of 
livers  and  ponds.  It  is  sometimes  cultivated  in  the  gardens  for 
medical  use.  The  leaves  of  wild  senna  — as  it  is  often  termed  — 
are  collected  in  August  or  the  beginning  of  September,  and  carefully 
dried.  It  is  in  full  bloom  in  the  months  of  July  and  August. 

In  the  shops  of  this  country,  the  leaves  are  often  met  with  in 
compressed  cakes,  prepared  by  the  Shakers;  they  have  a feeble 
smell,  and  a disagreeable  taste,  somewhat  resembling  that  of  senna. 
They  would  appear  to  contain  an  active  principle,  similar  to  the 
cathartin  of  senna;  and  they  yield  their  virtues  to  both  water  and 
alcohol. 

The  medical  virtues  of  American  senna  are  similar  to  those  of  the 
imported  article ; but  it  is  not  so  active,  requiring  to  be  given  in  a 
dose  about  one-third  larger.  It  may  be  prescribed,  like  senna,  in 
the  form  of  infusion. 

16.  JUGLANS.  — BUT'TERNUT. 

Butternut  is  the  inner  bark  of  the  root  of  Juglans  ciner'ea,  an  in- 
digenous forest  tree  known  not  only  under  the  name  of  butternut, 
but  also  of  oilnut  and  white  walnut;  Sex.  Syst.  Moncecia  Polyandria ; 
Nat.  Ord.  Terebinthacese ; — Juglandese,  (Lindley.)  It  grows  in  the 
Canadas,  and  in  the  northern,  eastern,  and  western  parts  of  the 
United  States  ; flowering  in  May,  and  the  fruit  ripening  in  September. 
The  inner  bark  of  the  root,  which  is  the  officinal  portion,  is  collected 
in  May  or  June. 

It  is  a gentle  cathartic,  resembling  rhubarb  in  its  operation,  and 
was  much  used  in  the  army  of  the  United  States  during  the  revo- 
lutionary war.  It  is  rarely,  however,  prescribed  in  the  cities.  It 
yields  its  virtues  to  water,  and  may,  therefore,  be  given  either  in  the 
form  of  decoction  or  of  extract.  The  latter  is  officinal.  Juglans 
itself  is  rarely  if  ever  prescribed  in  substance. 

EXTRAC'TUM  JUGLANTIS,  EXTRACT  OF  BUT'TERMT.  (Prepared  by  evapo- 
rating the  decoction  of  the  inner  bark  of  the  root  in  coarse  powder, 
or  by  the  process  of  displacement.) 

The  extract  often  found  in  the  shops  is  prepared,  by  the  country 
people,  from  a decoction  of  the  bark  of  the  branches,  and  it  is  said 
even  from  the  branches  themselves.  This,  as  suggested  by  Dr. 
Wood,  may  account  for  the  uncertainty  of  its  action.  The  dose  is 
20  or  30  grains. 


PODOPHYLLUM. 


179 


17.  PODOPHYL'LUM.~MAY  APPLE. 

Podophyllum^  of  the  Pharmacopoeia  of  the  United  States,  is  the 
rhlzoma  of  Podophyl  lum  pelta'tum;  Sex.  Syst.  Polyandria  Mono- 
gynia  ; Nat.  Qrd.  Ranunculacese ; — Podophylleae,  [Jussieu)^  Ber- 
beridaceae,  Fio-.  20. 

( Torrey  ^ 

Gray),  an 
indigenous 
herbaceous 
plant,  grow- 
ing exten- 
sively thro’ 
the  United 
States,  in 
moist  shady 
places,  and 
in  low 
marshy 
grounds, 

& common- 
ly known 
under  the 
name  of 
May  apple 
or  Man^ 
drake.  It 
flowers 
about  the 
end  of  May 
or  the  be- 
ginning of 
June,  and 
the  fruit, 
which  is 
sometimes 
preserved, 
ripens  in  the 

latter  part  of  September.  The  root  is  collected  after  the  leaves 
have  fallen  off. 

As  met  with  in  the  shops,  it  is  in  pieces  about  two  lines  thick, 
with  broad  flattened  joints  at  short  intervals ; is  wrinkled  longitudi- 
nally, and  of  a reddish  or  yellowish-brown  colour  externally.  In- 
ternally, it  is  of  a whitish  colour.  Its  taste  is  at  first  sweetish,  after- 
wards bitter,  nauseous,  and  slightly  acrid.  It  yields  its  virtues  both 
to  water  and  alcohol. 

The  powdered  root  resembles  jalap  m its  action,  and  may  be  used 


180 


SPECIAL  CATHARTICS. 


in  the  same  cases  and  forms  of  combination.  Its  dose  is  about  20 
grains. 

EXTRAC'TUM  PODOPHYl’LI,  EXTRACT  OF  MAY  APPLE.  (This  extract  is  direct- 
ed to  be  prepared  in  the  same  manner  as  the  Extractum  Jalapce, 
for  which  it  might  be  substituted.)  Its  dose  as  a cathartic  is  from  five 
to  fifteen  grains ; but  neither  it  nor  podophyllum  is  much  used  by 
the  profession  generally. 

18.  HYDRAR'GYRI  CHLO'RIDUM  MITif— MILD  CHLORIDE  OF  MER'- 

CURY. 

Mild  Chloride  of  Mer'cury,  Submu'riate  of  Mer'cury  or  Cal'omel,  is 
usually  prepared  by  sublimation.  According  to  the  Pharmacopceia 
of  theUnited  States,  a sulphate  of  mercury  is  first  formed  by  boiling 
two  pounds  of  mercury  in  three  pounds  of  sulphuric  acid,  until  the 
salt  is  left  dry.  This  is  then  rubbed,  when  cold,  with  the  remainder 
of  the  mercury,  until  they  are  thoroughly  mixed.  A pound  and  a 
half  of  chloride  of  sodium  is  now  rubbed  with  the  other  ingredients 
till  all  the  globules  disappear.  The  mild  chloride  is  then  sublimed, 
and  afterwards  reduced  to  powder,  and  washed  frequently  with  boil- 
ing distilled  water,  till  the  washings  afford  no  precipitate  upon  the 
addition  of  solution  of  ammonia. 

If  no  metallic  mercury  were  added  in  this  process,  the  sublimate 
would  be  corrosive  chloride. 

As  prepared  in  the  above  way,  there  is  always  some  corrosive  sub- 
limate mixed  with  the  mild  chloride,  which  is  removed  by  the  wash- 
ing directed  in  the  process.  With  the  same  view,  and  to  obtain  it 
in  a state  of  minute  division,  the  mild  chloride  in  vapour  is  made 
to  come  in  contact  with  steam  in  the  subliming  vessel  by  which  it  is 
condensed. 

Calomel  is  also  occasionally  made  by  precipitation  from  a solu- 
tion of  mercury  in  nitric  acid^  as  much  as  possible  in  the  state  of  pro- 
toxide, and  adding  to  it  chloride  of  sodium.  By  this  process,  it  is 
obtained  in  a state  of  very  fine  division. 

When  well  prepared,  the  two  calomels  are  essentially  alike  in 
therapeutical  properties  ; but  the  one  by  sublimation  is  generally  pre- 
ferred. Neither  one  nor  the  other  is  made  by  the  ordinary  apothe- 
cary, but  by  the  manufacturing  chemist  on  a large  scale. 

Calomel,  prepared  in  the  ordinary  mode  by  sublimation,  forms  a 
crystalline  cake,  the  shape  of  which  is  dependent  upon  that  of  the 
subliming  vessel.  The  crystals  are  square  prisms.  As  seen,  how- 
ever, in  the  shops,  it  is  in  fine  powder,  devoid  of  taste  and  smell,  and 
of  a light  buff  colour.  That,  which  results  from  the  vapour  being 
condensed  by  steam,  is  perfectly  white. 

It  is  wholly  volatilised  by  heat,  and  is  insoluble  in  water,  alcohol 
and  ether.  By  exposure  to  light  it  becomes  darker  coloured,  and 
hence  ought  to  be  kept  in  a bottle  coated  with  black  paper,  or  be  paint- 
ed black.  By  the  alkalies  or  alkaline  earths,  it  is  immediately 


HYDRARGYRI  CHLORIDUM  MITE. 


181 


blackened,  owing  to  the  formation  of  protoxide  of  mercury.  Should 
it  contain  corrosive  chloride,  — when  distilled  water  is  boiled  with 
it,  a white  precipitate  will  be  caused  on  the  addition  of  ammonia. 

Mild  chloride  of  mercury  is  in  much  use  as  a cathartic,  and  per- 
haps nowhere  more  so  than  in  the  United  States.  It  has  been  else- 
where remarked,  that  it  is  one  of  the  cathartics  that  do  not  act  in  a 
direct  ratio  with  the  dose  ; indeed,  it  often  happens,  that  whilst  three 
or  four  grains  operate  freely,  twenty  or  thirty  may  exert  but  little 
agency.  In  the  latter  quantity  it  has  been  advised  to  allay  irrita- 
bility of  the  stomach  or  bowels  in  numerous  diseases,  and  especially 
in  spasmodic  cholera,  in  which  it  has  been  administered  in  enormous 
quantities  by  some,  under  the  idea  that  large  doses  act  as  a sedative. 
Yet  this  sedative  influence  — if  it  exist — must  be  confined  within 
certain  limits,  otherwise  the  immense  doses  occasionally  given  — 
amounting  even  to  drachms  — ought  to  be  attended  with  fatal  con- 
sequences. It  has  been  already  shown,  that  according  to  the  idea  of 
Rasori,  all  cathartics  act  best  in  moderate  doses,  and  that  when  they 
are  given  beyond  a certain  amount  they  prove  sedative  rather  than 
cathartic. 

Calomel  is  essentially  a cholagogue  cathartic,  acting  upon  the 
upper  part  of  the  intestines  more  especially,  and  by  contiguous  sym- 
pathy upon  the  liver  ; hence  its  operation  is  often  attended  with  a 
copious  discharge  of  bile,  which,  as  already  remarked,  may  be  no 
evidence  that  the  individual  is  bilious^  but  merely  that  he  has  taken 
a cathartic,  which  acts  upon  the  lining  membrane  of  the  duodenum, 
and  thus  augments  the  biliary  secretion.  The  source  of  the  green 
stools,  or  calomel  stools  which  succeed  to  its  repeated  employment, 
has  been  a subject  of  difiference  of  opinion  : they  appear  to  be  owing 
to  a modified  secretion  of  the  whole  glandular  and  follicular  appara- 
tus connected  with  the  intestinal  canal,  ail  of  which  it  certainly  ex- 
cites to  greater  action. 

With  many  persons  — perhaps  with  most  — when  taken  to  the 
extent  of  inducing  purging,  calomel  causes  more  or  less  nausea,  and 
at  times  vomiting  ; and  not  unfrequently  its  action  is  accompanied 
by  griping.  Notwithstanding  these  inconveniences,  however,  it  is 
an  excellent  cathartic,  especially  when  taken  at  night  in  the  form  of 
pill,  and  followed  up  by  some  saline  or  other  cathartic,  of  more  gene- 
ral and  speedy  action,  on  the  following  morning.  It  is  likewise  an 
excellent  adjunct  to  other  cathartics,  and  hence  — where  there  is  no 
special  objection  to  its  employment  — it  is  a common  and  effective 
ingredient  in  most  active  cathartic  pills. 

It  is  also  a very  common,  cathartic  for  children,  in  consequence  of 
the  facility  with  which  it  can  be  administered.  The  only  objection 
to  it  is,  that  in  habits  which  are  very  impressible  to  the  action  of  mer- 
cury, it  is  apt  to  affect  the  mouth,  even  when  every  precaution  has 
been  taken  ; and,  in  children  especially,  to  induce  stomatitis,  with 
foetor  of  the  breath,  increased  flow  of  saliva,  troublesome  ulcerations, 
VOL.  I. — 16 


182 


SPECIAL  CATHARTICS. 


and,  in  rare  cases,  sloughing  of  the  gums  and  cheeks,  and  even  ne- 
crosis of  the  bones  of  the  face.  It  is  proper,  however,  to  remark, 
that  the  author  has  noticed  some  cases  in  which  these  phenomena 
presented  themselves  where  no  mercury  had  been  taken.  Still,  it 
must  be  admitted,  that  where  a disposition  exists  to  such  stomatitis, 
it  may  be  developed  by  the  use  of  a calomel  purge.  The  author  has 
observed,  that  particular  persons  are  unusually  susceptible  to  mer- 
cury, and  have  the  constitutional  phenomena,  pointed  out  elsewhere, 
induced  by  a very  small  quantity  of  it ; and  in  public  practice  he  has 
remarked,  that  at  certain  seasons  or  periods  almost  every  patient  in 
the  wards  of  the  hospital  could  be  affected  with  mercury  by  the  ex- 
hibition of  a pill  of  a few  grains  of  calomel,  or  even  of  the  pilulee 
hydrargyri.  This  disagreeable  result  is  less  to  be  apprehended 
under  the  age  of  two  years,  — children  at  that  early  age  resisting  the 
action  of  mercury,  to  which  they  are  so  susceptible  at  an  after  period. 

Associated  with  opium,  calomel  is  a valuable  agent  in  many  in- 
testinal affections  accompanied  with  constipation,  or  in  w^hich  it  is 
desirable  to  gently  excite  the  action  of  the  canal,  to  remove  scybala 
or  irritating  matters  ; for  example,  in  various  species  of  colic  ; in 
enteritis  after  blood-letting  — the  opium  acting  as  a sedative  in  the 
dose  of  two  or  three  grains,  and  the  same  amount  of  calomel  asso- 
ciated with  it,  then  operating  as  a cathartic  — and  in  diarrhcea,  dy- 
sentery, &c.  It  is  a cathartic  often  employed  in  cases  of  worms, 
appearing  to  act  not  simply  by  dislodging  the  parasites,  but  by 
proving,  in  some  measure,  anthelmintic. 

In  Great  Britain,  the  ordinary  dose  of  calomel  as  a cathartic  is 
from  two  to  five  grains  ; and  in  France  it  is  rarely  given  to  this  ex- 
tent, whilst  in  this  country  the  average  dose  may  be  stated  at  from 
five  to  fifteen  grains.  As  already  remarked,  its  action  does  not  aug- 
ment in  a direct  ratio  wdth  the  dose.  On  the  contrary,  the  author 
has  instituted  numerous  experiments  in  public  practice,  and  has  found 
that,  as  a general  rule,  five  grains  are  more  certain  in  their  opera- 
tion than  twenty.  In  all  cases,  when  calomel  does  not  act  upon  the 
oowels,  another  cathartic  should  be  administered,  as  its  retention 
may  induce  the  constitutional  effects  of  the  remedy.  Children  ge- 
nerally require  almost  as  large  a dose  as  adults,  a child  of  two  years 
of  age  requiring  three  to  five  grains  ; — their  intestinal  canals  not 
seeming  to  be  more  impressible  to  the  action  of  this  irritant  than 
those  of  adults. 

The  United  States  Pharmapopceia  has  a form  for  the  PIL'UlJi 
IIYDRAR'GYRI  CHLOR'IDI  MITIS,  or  Pills  of  mild  chloride  of  mercury,  in 
which  the  calomel  is  made  into  pills  of  one  grain  each  by  means  of 
gum  arabic  powder  and  syrup.  Calomel  pills  are  generally,  how- 
ever, made  extemporaneously  with  the  same  excipients  or  with  con- 
fection of  roses  ; and  they  have  the  advantage,  that  they  separate 
more  readily  in  the  stomach  ; whilst  calomel  pills,  that  have  been 
long  kept  in  the  shops,  have  been  known  to  pass  through  the  whole 
tract  of  the  intestines  unchanged. 


PILULiE  HYDRARGYRI. 


183 


Mild  chloride  of  mercury  is  employed  in  the  formation  of  the  Hy~ 
drargyri  Oxidum  JYigrum^  and  it  is  one  of  the  ingredients  of  the 
Pilulce  Catharticce  Compositx  of  the  Pharmacopoeia  of  the  United 
States. 

PIL^UL^  HYDRAR'GYRI— MERCU'RIAL  PILLS. 

Mercurial  pills  or  blue  pills  are  formed  by  rubbing  mercury  with 
confection  of  roses^  till  all  the  globules  disappear,  and  then  adding 
liquorice  powder^  beating  the  whole  into  a mass.  In  the  Pharma- 
copoeias of  London  and  the  United  States,  one  grain  of  mercury  is 
contained  in  three  of  the  mass,  — blue  mass,  as  it  is  called  from  its 
colour. 

Even  at  the  present  day,  after  much  attention  has  been  paid  to 
the  subject,  it  is  a matter  of  dispute  as  to  what  is  the  condition  of 
the  mercury  contained  in  this  preparation,  as  w^ell  as  in  others  where 
it  is  divided  by  friction  with  substances  not  apparently  adapted  for 
exerting  any  chemical  agency  upon  it,  — as  in  the  Ungueutum  Hy- 
drargyri,  and  the  Hydrargyrum  cum  Cretd.  Many  distinguished 
chemists  of  the  day  are  disposed  to  regard  it  as  merely  in  a state  of 
mechanical  division.  In  the  absence  of  chemical  proofs,  it  would 
be  an  objection  to  this  view,  that  metallic  mercury  is  admitted  to  be 
wholly  without  action  on  the  living  economy.  It  has  been  found  re- 
cently, however,  that  the  vapour  disengaged  from  mercury  at  atmo- 
spheric temperatures  contains  some  oxide  ; and  it  is  affirmed  by  a 
distinguished  pharmacological  writer.  Dr.  Christison,  that,  during 
the  last  eight  years,  he  has  examined  various  samples  of  the  Unguen- 
turn  Hydrargyri,  and  has  never  failed  to  detect  a sensible  propor- 
tion of  oxide  in  it;  and  “although  the  same  fact,’’  he  adds,  “has 
not  yet  been  proved  of  the  pill  and  powders  of  ^mercury,  there  is  not 
yet  any  conclusive  evidence  to  the  contrary.” 

Although,  therefore,  the  point  is  unsettled,  it  may  be  esteemed 
probable,  that  a portion  at  least  of  the  divided  mercury  in  the  Pi- 
lulus  Hydrargyri  has  undergone  oxidation.  It  was  under  the  idea, 
that  the  metal  is  in  the  state  of  protoxide,  that  Mr.’  Donovan  pro- 
posed, that  the  protoxide  should  be  introduced  into  the  materia  me- 
dica.  This  is  the  HYDRAR'GYRI  OX  IDUM  NIGRUM  of  the  Pharmacopoeia  of 
the  United  States;  the  Hydrargyri  oxidum,  of  that  of  London,  the 
Suboxide^  Ash^  Gray,  or  Black  oxide  of  mercury.  It  is  the  precipitate 
thrown  down  from  the  mild  chloride  of  mercury  by  means  of  potassa. 
It  is  rarely,  however,  used  internally,  and  owing  to  the  occasional  pre- 
sence of  the  peroxide,  is  liable  to  operate  harshly.  Under  another 
head,  it  will  be  seen,  that  it  is  employed  externally  as  a mercurial 
revellent. 

When  the  Pilulse  Hydrargyri  are  given  as  a cathartic,  the  dose 
may  be  five  grains  at  night,  followed  by  a draught  of  senna  and 
sulphate  of  magnesia,  or  sulphate  of  magnesia  alone  on  the  follow- 
ing morning.  Of  itself,  it  will  rarely  act  satisfactorily  as  a cathartic. 


184 


SPECIAL  CATHARTICS. 


'Hie  practice  of  administering  it  as  above  mentioned  became  com- 
mon and  empirical,  greatly  owing  to  the  frequent  recommendations 
of  it  by  the  late  Mr.  Abernethy  in  disorders  of  the  digestive  func- 
tion ; and  the  author  has  seen  many  cases  in  which  mischief  was 
produced  thereby.  A constant  repetition  of  such  agents  is,  indeed, 
as  elsewhere  remarked,  well  adapted  for  inducing  all  the  characters 
of  bilious  affections,  which,  in  the  generality  of  cases,  are,  in  strict 
pathology,  derangements  of  the  stomach  and  intestines  ; and  it  need 
scarcely  be  repeated,  that  too  frequently  a repetition  of  cathartics 
may  give  rise  to  the  very  evils,  for  the  fancied  removal  of  which  they 
are  administered. 

An  intelligent  writer  has  properly  animadverted  on  the  mischief 
resulting  from  the  constant  call  for  “ a blue  pill  at  night  and  a pot 
of  faeces  in  the  morning.” 

SALINE^  CATIIAr'tICS. 

As  the  saline  cathartics  act  much  alike,  they  may  be  classed  toge- 
ther. They  are  generally  given  much  diluted  with  water.  When 
concentrated,  they  would  seem,  according  to  Liebig,  to  have  a phy- 
sical, as  well  as  a dynamic  action.  They  extract  water  from  the 
coats  of  the  stomach  and  thence  create  thirst.  Part  of  the  solution 
. becomes  diluted  in  this  way,  and  is  absorbed ; but  the  greater  part 
passes  into  the  intestines,  dilates  the  solid  matters,  and  acts  as  a 
cathartic. 

20.  MAGNE^SI^  SULPHAS.— SULPHATE  OF  MAGNE'SIA. 

Sulphate  of  magnesia  is  the  common  Epsom  salts^  or  Bitter  purg- 
ing salts.  It  is  a constituent  of  sea  water,  and  of  many  mineral 
springs  ; and  is  found  in  some  soils,  sometimes  efflorescing  in  capil- 
lary crystals  ; and  in  this  country  is  met  with  abundantly  in  many 
of  the  caverns  on  the  west  of  the  Alleghany  mountains. 

Formerly,  Epsom  salts  were  prepared  exclusively  from  the  Epsom 
waters  by  evaporation  and  crystallisation,  and  the  salt  is  still  pre- 
pared from  the  springs  of  Seidlitz  and  Seydschutz.  In  Great  Britain 
it  is  made  either  from  Dolomite  or  Magnesian  limestone,  by  con- 
verting the  carbonate  of  magnesia  into  a sulphate ; or  from  the  bit- 
tern left  after  the  preparation  of  common  salt,  from  which  it  is  ob- 
tained by  simple  evaporation  and  crystallisation.  In  Baltimore,  it 
is  extensively  manufactured  from  magnesite  — the  siliceous  hydrate 
of  magnesia,  which  abounds  in  the  neighbourhood  of  that  city.  It 
contains  less  lime  than  dolomite.  These  works  supply  the  United 
States.  Sulphate  of  magnesia  is  always  prepared  by  the  manufac- 
turing chemist,  and  the  quantity  annually  consumed,  in  the  forma- 
tion of  magnesia,  and  as  a therapeutical  agent,  is  enormous. 

Sulphate  of  magnesia  — as  met  with  in  the  shops  — is  sufficiently 
pure  for  medicinal  purposes.  It  is  in  small  acicular  crystals  ; but 
by  solution,  and  re-crystallisation,  tolerably  large  rhombic  prisms, 
H^often  truncated  on  the  obtuse  edges,  and  terminated  by  two  or  tour 


SODiE  SULPHAS. 


185 


converging  planes,  are  obtained.  The  crystals  are  colourless,  trans- 
parent, without  smell,  but  of  a bitter,  disagreeable  taste.  The  pure 
sulphate  effloresces,  but,  owing  to  an  admixture  of  muriate  of  mag- 
nesia, it  occasionally  deliquesces.  It  dissolves  in  its  own  weight 
of  water  at  60°  Fahr.,  and  three^fourths  of  its  weight  of  boiling 
water.  It  is  insoluble  in  alcohol. 

Sulphate  of  magnesia  possesses  the  characters  of  the  whole  class 
of  saline  cathartics,  acting  upon  the  entire  tract  of  the  intestinal 
canal,  and  increasing  the  secretion  from  the  lining  membrane,  and 
at  the  same  time  the  peristaltic  action  ; so  that  the  evacuations 
are  numerous  and  watery.  The  great  objection  to  it  is  its  nau- 
seous taste,  yet  it  often  remains  on  the  stomach  when  other  cathar- 
tics would  be  rejected.  This  is  especially  the  case  with  a mixture 
of  the  sulphate  of  magnesia  and  the  carbonate  as  in  the  following 

form: Magnes.  sulphat.  ^vj  ; Magnes.  carhonat.  >^ij  ; Aquce  menthce. 

piperit.  ^iiss.  M.  Dose,  one  half,  to  be  repeated  if  necessary. 

Alone,  or  associated  with  infusion  of  senna,  it  is  one  of  the  most 
common  cathartics,  both  with  the  professional  and  the  unprofessional. 
Like  all  the  saline  cathartics,  (as  elsewhere  remarked,)  it  operates 
best  when  dissolved  in  a large  quantity  of  water.  The  ordinary  dose 
is  one  ounce  ; but  in  cases  of  constipation  it  is  best  to  administer  a 
small  quantity  — as  a drachm  — every  morning,  until  the  sensibility 
of  the  mucous  membrane  is  developed  to  the  necessary  degree, 
which  it  generally  will  be  sooner  or  later.  The  addition  of  diluted 
sulphuric  acid,  or  of  elixir  of  vitriol,  so  as  to  form  a supersulphate  of 
magnesia^  adapts  it  as  an  excellent  laxative  and  local  stimulant  in 
cases  of  hemorrhage  from  the  stomach  and  intestines.  In  the 
dose  of  an  ounce  or  two,  it  is  prescribed  as  an  adjunct  to  cathartic 
enemata. 

Chloride  of  magnesium,  or  Muriate  of  Magnesia. — Magne'sii 
chlo'ridum,  Magne'siai:  mu'rias,  has  been  recommended  as  a saline 
cathartic  by  Dr.  Lebert.  It  is  said  to  exert  no  injurious  effect  on  the 
stomach  ; and  to  produce  less  inconvenience  than  most  other  cathar- 
tics. Its  purgative  action  is  said  to  be  followed  by  improvement  of 
the  appetite.  The  mean  dose  for  an  adult  is  an  ounce  ; and  half  that 
quantity  for  one  from  ten  to  fourteen  years  of  age. 

21.  SOD^  SULPHAS.— SULPHATE  OF  SODA, 

Sulphate  of  soda,  commonly  called  Glauherh  salts,  is  contained  in 
many  mineral  springs,  and  is  produced  artificially  in  several  chemi- 
cal processes.  It  is  rarely,  or  never,  prepared  by  the  apothecary, 
being  manufactured  on  a very  extensive  scale  by  the  wholesale  che- 
mist. It  is  made  from  the  salt  remaining  after  the  preparation  of 
chlorohydric  or  muriatic  acid ; which  is  sulphate  of  soda,  usually 
with  the  addition  of  free  sulphuric  acid.  To  neutralise  this,  the 
London  College  directs  carbonate  of  soda ; the  Edinburgh  College, 
16* 


186 


SPECIAL  CATHARTICS. 


carbonate  of  lime.  The  latter  is  more  economical.  It  would  appear, 
too,  that  in  consequence  of  the  enormous  consumption  of  sulphate  of 
soda,  in  the  manufacture  of  carbonate  of  soda,  the  sulphate  is  some- 
times made  directly  by  the  addition  of  sulphuric  acid  to  chloride  of 
sodium.  In  some  of  the  Northern  States,  particularly  in  Massachu- 
setts, a portion  of  Glauber’s  salt  is  procured  from  sea-water  in  the 
winter  season.  During  the  prevalence  of  very  cold  weather,  sulphate 
of  soda,  being  the  least  soluble  salt,  that  can  be  formed  of  the  acids  • 
and  bases  present,  separates  in  the  form  of  crystals.  ( Wood  and 
Bache.) 

Sulphate  of  soda  is  in  colourless  crystals,  having  the  same  crys- 
talline form  as  sulphate  of  magnesia  and  sulphate  of  zinc,  which  it 
resembles  in  general  appearance.  It  rapidly  effloresces  on  exposure 
to  the  air,  and  ultimately  falls  into  a white  powder.  It  dissolves  in 
three  parts  of  water  at  60°,  and  in  one  part  at  212°  ; and  is  insoluble 
in  alcohol.  Its  taste  is  cooling,  but  bitter  and  very  nauseous,  which 
is  the  great  objection  to  it  as  an  internal  medicine.  Owing  to  its 
cheapness,  it  is  not  subject  to  adulteration,  and  as  met  with  in  the 
shops,  is  adapted  for  all  therapeutical  purposes. 

In  its  medical  properties,  sulphate  of  soda  is 'similar  to  sulphate  of 
magnesia,  which  has  now  taken  its, place.  When  the  author  was  a 
pupil  in  the  North  of  England,  the  sulphate  of  soda  being  somewhat 
cheaper  than  the  sulphate  of  magnesia  was  the  common  purgative 
with  the  people  ; whilst  the  latter,  being  somewhat  less  disagreeable, 
was  used  by  the  better  classes.  An  ordinary  dose  of  salts  is  one 
ounce  : this  may  be  taken  dissolved  in  water,  to  which  a little  dilute 
sulphuric  acid,  bitartrate  of  potassa,  or  lemon-juice  has  been  added ; 
or  in  mint  water,  which  masks,  in  some  degree,  its  disagreeable 
taste. 

If  in  an  effloresced  state,  or  dried  so  that  its  water  of  crystallisation 
is  expelled,  half  the  quantity  will  be  a sufficient  dose. 

SODiE  ET  POTAS'S^  TARTRAS.— TARTRATE  OF  POTAS'SA  AND 

SODA. 

This  salt,  formerly  called  Seignette^s  salt,  and  still  not  unfrequently 
termed  Rochelle  salt,  is  made  by  neutralising  bitartrate  of  potassa  with 
carbonate  of  soda, — the  excess  of  acid  in  the  bitartrate  being  saturated 
by  the  soda  of  the  carbonate,  whilst  the  carbonic  acid  is  disengaged. 

It  is  in  colourless,  transparent  crystals,  which  are  prisms  or  halves 
of  prisms,  presenting  six,  eight  or  ten  sides,  and  the  primitive 
form  of  which  is  the  right  rhombic  prism.  It  effloresces  slightly  in 
dry  air,  and  is  wholly  and  readily  dissolved  in  five  parts  of  boiling 
water.  Its  taste  is  saline  and  slightly  bitter.  It  is  not  liable  to 
adulteration. 

Tartrate  of  potassa  and  soda  is  a mild  refrigerant  cathartic, — 
less  disagreeable  to  the  taste  than  the  neutral  salts  generally  em- 
ployed, It  is  a constituent  of  the  Seidlitz  powders — so  called  — 


POTASSiE  TARTRAS. 


187 


which  consist  of  a mixture  of  two  drachms  of  this  salt,  and  two 
scruples  of  bicarbonate  of  soda,  put  up  in  a white  paper ; and  of 
thirty-five  grains  of  tartaric  acid  in  a blue  paper.  These  are  dissolved 
separately  in  water,  and  taken  in  the  state  of  effervescence. 

The  dose  of  tartrate  of  potassa  and  soda  is  from  ^ss.  to  jj. 

23.  SOD^  PHOSPHAS.— PHOSPHATE  OF  SODA. 

This  salt,  sometimes  called  tasteless  purging  salts,  is  prepared  from 
bone  earth.  A formula  is  given  in  the  Pharmacopoeia  of  the  United 
States.  In  this,  sulphuric  acid  is  made  to  act  upon  bone  ash,  which 
consists  of  phosphate  of  lime  united  with  some  carbonate.  In  this 
manner,  sulphate  and  superphosphate  of  lime  result ; the  latter  of 
which  remains  in  solution, — the  former  being  mainly  precipitated. 
Carbonate  of  soda  is  then  added;  phosphate  of  lime  is  precipitated, 
and  carbonic  acid  disengaged.  The  formation  of  crystals  of  phos- 
phate of  soda  is  promoted  by  a slight  excess  of  carbonate  of  soda. 

Phosphate  of  soda  is  in  colourless  transparent  crystals,  which 
speedily  effloresce  on  exposure  to  the  air,  and  are  in  oblique  rhombic 
prisms.  It  has  a mild  saline  taste,  resembling  that  of  common  salt; 
has  an  alkaline  reaction,  and  yields  a yellow  precipitate  with  nitrate 
of  silver,  which  is  soluble  both  in  nitric  acid  and  ammonia.  It  dis- 
solves in  four  times  its  weight  of  cold,  and  twice  its  weight  of  hot 
water,  and  is  almost  insoluble  in  alcohol.- 

Phosphate  of  soda  possesses  the  same  virtues  as  the  other  saline 
cathartics,  with  this  advantage,  that  its  taste  is  far  more  agreeable.' 
It  may  be  given  in  soup  or  gruel,  to  which  it  communicates  a taste 
like  that  of  common  salt.  It  may  be  given  also  to  children  more 
easily  than  any  other  cathartic  of  the  class.  By  those,  who  considered 
it  desirable  to  restore  to  the  blood  the  saline  matter,  which  it  had  lost 
in  spasmodic  cholera,  the  phosphate  of  soda  was  often  selected  as 
the  saline  agent. 

The  dose  as  a cathartic  is  from  jj.  to  gij. 

24.  POTAS'SiE  TARTRAS. —TARTRATE  OF  POTAS'SA. 

Tartrate  of  potassa  or  soluble  tartar  is  made  by  neutralising  the 
excess  of  acid  in  the  bitartrate  of  potassa  by  the  addition  of  a boiling 
solution  of  carbonate  of  potassa.  The  tartaric  acid  unites  with  the 
potassa,  and  the  carbonic  acid  is  disengaged,  after  which  some  in- 
soluble tartrate  of  lime  is  separated  by  filtration;  and  the  liquor  is 
evaporated  so  that  the  tartrate  may  crystallise  on  cooling. 

When  properly  prepared,  it  is  in  white  crystals,  which  are  some- 
what deliquescent,  or  become  moist  in  damp  air;  and  are  entirely 
soluble  in  their  own  weight  of  water.  Its  taste  is  saline,  and  some- 
what bitter:  most  commonly,  it  is  in  a granular  state,  owing  to  the 
solution  being  evaporated  to  dryness. 

Tartrate  of  potassa  is  a mild  cathartic ; but  is  rarely  given  alone. 
It  is  sometimes  added  to  other  cathartics,  as  the  infusion  of  senna,  the 


188 


SPECIAL  CATHARTICS. 


griping  effects  of  which  it  is  said  to  correct  like  the  saline  cathartics 
in  general.  It  is  occasionally  administered  as  a refrigerant  laxative 
in  febrile  affections. 

The  dose,  as  a laxative,  is  a drachm  or  two;  as  a purgative,  §ss. 

to  3j- 

25.  POTAS’S^  BITAR'TRAS.— BITART'RATE  OF  POTAS'SA. 

Bitartrate  of  potassa;  supertartrate  of  potassa,  acidulous  tartrate  of 
potassa  or  cream  of  tartar  is  the  crude  tartar^  argol  or  impure  super- 
tartrate  of  potassa  purified.  Tartar  exists  in  grape  juice,  but  as  it  is 
very  slightly  soluble  in  alcohol  and  water,  it  is  deposited  when 
alcohol  is  produced,  and  forms  an  incrustation  on  the  sides  of  the 
wine  casks.  This  is  purified  on  a large  scale,  in  France,  by  solution 
and  crystallisation,  and  it  is  from  that  country,  that  we  receive  it. 
The  purest  salt  is  obtained,  according  to  Dr.  Christison,  by  dissolving 
that  w'hieh  has  been  purified,  gradually  evaporating  the  solution,  and 
removing  the  crust  of  bitartrate,  which  forms  on  the  surface,  and 
which  has  given  the  name  cream  of  tartar  to  the  salt. 

As  met  with  in  the  shops,  it  has  either  the  form  of  w^hite  crystalline 
crusts,  which  are  gritty  under  the  teeth,  or,  what  is  more  common, 
of  a fine  white  pow^der.  It  is  devoid  of  smell,  but  has  an  acidulous 
and  not  disagreeable  taste.  It  is  soluble  in  90  parts  according  to 
some  — 60  according  to  others  — of  cold  water;  and  in  about  15  of 
boiling  wmter  ; and  is  insoluble  in  alcohol.  It  is  liable  to  be  adul- 
terated by  white  mineral  and  other  powders,  and  usually  contains 
from  2 to  5 per  cent,  of  tartrate  of  lime,  which  does  not,  how^ever, 
interfere  much  with  it  in  a medical  point  of  view.  When  pure,  it 
is  wholly  soluble  in  boiling  water ; and  if  impure,  the  extraneous 
matters  remain  undissolved.  Should  it  be  adulterated  by  either 
alum  or  bisulphate  of  potassa,  the  fraud  will  be  detected  by  the 
chloride  of  barium,  which  throws  down  white  sulphate  of  baryta, 
insoluble  in  nitric  acid. 

In  small  doses,  bitartrate  of  potassa  is  a gentle  laxative,  and, 
associated  with  sulphur,  is  a common  domestic  remedy  for  preserving 
the  health  of  children  in  spring  and  autumn.  In  larger  doses,  it 
acts  more  powerfully,  and  is  often  given  along  wdth  j:ilap,  senna,  and 
other  cathartics  to  exert  a hydragogue  effect.  When  prescribed  as 
an  aperient,  it  may  be  in  the  dose  of  a drachm  or  two  ; as  a hydra- 
gogue cathartic,  from  half  an  ounce  to  an  ounce  ; and  as  good  a 
vehicle  as  any  is  molasses.  When  associated  with  sulphate  of  mag- 
nesia, its  acidity  masks  the  disagreeable  taste  of  the  latter  ; and  a 
solution,  formed  of  the  two,  makes  an  excellent  aperient  in  habitual 
constipation.  (See  page  141.) 

Bitartrate  of  potassa  is  employed  in  the  preparation  of  the  anti- 
monii  et  potassce  tartras^  the  ferri  et  potassce  tartras^  the  potasses 
tartras,  the  pulvis  jalapee  compositus^  and  the  sodee  et  potassa  tartras 
of  the  Pharmacopoeia  of  the  United  States. 


POTASSiE  SULPHAS. 


189 


26.  POTAS'S.E  SULPHAS.  — SULPHATE  OF  POTAS'SA. 

Sulphate  of  potassa,  — of  old,  sal  poVychrest  or  salt  of  many 
virtues^  — is  found  in  both  kingdoms  of  nature,  but  that  which  is 
used  as  a medicine  is  prepared  artificially.  It  is  made  on  the  large 
scale  from  the  salt,  which  remains  after  the  distillation  of  nitric  acid 
from  nitrate  of  potassa.  This  has  an  excess  of  sulphuric  acid,  which 
may  be  neutralised  — as  directed  by  the  Dublin  College,  — by 
carbonate  of  potassa.  The  London  College  ignites  the  salt  in  a 
crucible,  until  the  excess  of  sulphuric  acid  is  entirely  expelled  ; 
whilst  the  Edinburgh  College  neutralises  it  with  carbonate  of  lime. 
Both  of  these  processes  are  more  economical  than  that  of  the  Dublin 
College. 

As  we  meet  with  it,  sulphate  of  potassa  has  usually  the  shape  of  sin- 
gle or  double  six-sided  pyramids.  The  crystals  are  of  a white  colour, 
very  hard  and  permanent  in  the  air  ; devoid  of  smell,  and  of  a bitter 
saline  taste.  They  require  sixteen  times  their  weight  of  water  at  60° 
to  dissolve  them,  and  five  times  their  weight  of  boiling  water  ; and 
are  insoluble  in  alcohol. 

Sulphate  of  potassa  is  a mild  cathartic,  operating  without  any  un- 
pleasant concomitants  ; but  it  is  rarely  employed.  As  a laxative,  it 
might  be  given  in  the  dose  of  20  or  30  grains  ; as  a purge,  in  doses  of  4 
or  5 drachms.  It  is  sometimes,  but  not  often,  combined  with  rhu- 
barb, in  dyspeptic  cases,  and  in  gastro-intestinal  affections  of  chil- 
dren, which  are  accompanied  with  constipation- 

It  enters  into  the  composition  of  the pulvis  ipecaciianhss  compositus, 
or  Dover’’ s powder,  — not  on  account  of  its  medical  virtues,  but  be- 
cause — by  reason  of  its  hardness — it  facilitates  the  division  of  the 
opium. 

Cases  have  been  recently  published,  in  which  large  doses  of  the 
salt  — an  ounce  and  upwards — given  as  a cathartic,  have  proved 
fatal.  It  would  seem,  that  the  salt  is  constantly  employed  in  France 
as  a domestic  remedy  by  nurses,  to  diminish  or  stop  the  flow  of  milk 
in  puerperal  females  ; and  it  is  supposed,  both  in  that  country  and  in 
England,  to  have  the  power  of  inducing  abortion.  It  is  very  diffi- 
cult to  pulverise  ; and  a portion  of  its  irritating  properties  may  be 
dependent  upon  mechanical  excitation  of  the  mucous  surfaces  with 
which  it  comes  in  contact. 


Bisulph'ate  or  supersulph' ate  of  potas’sa,  Potas'sa:  bisul'phas,  is 
officinal  in  the  British  Pharmacopoeias.  The  London  and  Edinburgh 
Colleges  direct  it  to  be  made,  by  adding  sulphuric  acid  to  a solution 
of  the  salt  that  remains  after  the  distillation  of  nitric  acid.  It  is  a 
white  salt  ; has  a very  acid  taste  and  reaction,  and  is  soluble  in 
twice  its  weight  of  water  at  60°. 

Bisulphate  of  potassa  may  be  given  in  the  same  cases  as  sulphate 
of  magnesia,  with  excess  of  sulphuric  acid.  Like  the  sulphate  of 
potassa  it  is  laxative,  and  has  the  advantage  of  being  more  soluble  ; 
but  cannot  always  be  substituted  for  it.  It  cases  of  want  of  tone  of 


190 


SPECIAL  CATHARTICS. 


the  digestive  organs,  accompanied  by  diminished  secretion  of 
acid,  the  acid  acts  beneficially  as  a tonic ; and  in  hemorrhage 
from  the  bowels,  good  may  result  from  the  local  astringent  influence 
of  the  acid  on  the  v^essels  concerned,  whilst  the  salt  may  carry  ofl’the 
blood  that  has  been  eflfused.  It  is  not,  however,  much  prescribed  at 
the  present  day,  and  perhaps  not  at  all  on  this  side  of  the  Atlantic. 

27.  POTAS'S^  ACE'TAS.  — AC"ETATE  OF  POTAS'SA. 

This  salt  may  be  formed  by  the  direct  combination  of  acetic  acid 
and  carbonate  of  potassa  ; evaporating  and  crystallising.  The  acid 
unites  with  the  potassa  of  the  carbonate,  and  carbonic  acid  is  disen- 
gaged. 

As  met  with  in  the  shops,  it  has  a white,  foliaceous,  satiny  ap- 
pearance ; is  soapy  to  the  feel,  inodorous,  and  has  a strong  saline, 
warm,  and  rather  acrid  taste.  It  is  extremely  deliquescent,  and 
therefore  requires  to  be  excluded  carefully  from  the  air.  At  60° 
Fahr.,  according  to  Dr.  Pereira,  100  parts  dissolve  in  102  of  water.  It 
is  very  soluble  likewise  in  alcohol.  When  pnre,  it  is  perfectly  neu- 
tral, and  does  not  change  the  colour  of  litmus  or  turmeric.  It  is 
rarely  adulterated,  and  never  perhaps  so  as  to  interfere  with  its  medi- 
cinal use.  The  Pharmacopoeias  of  London  and  the  United  States 
lay  down  certain  tests  of  its  purity ; but  the  Edinburgh  considers 
them  unnecessary. 

Acetate  of  potassa  is  a mild  cathartic  ; but  it  has  been  more  cele- 
brated as  a diuretic,  whence  its  old  name  sal  diurdicus.  Owing  to 
its  affecting  both  the  intestines  and  kidneys,  it  has  been  prescribed 
as  a cathartic  and  diuretic  in  dropsy.  To  produce  the  former  effect, 
it  should  be  given  in  the  dose  of  3ij  to  3iij* 

28.  SO'DII  CHLO'RIDUIM  — CHLORIDE  OF  SO'DIU.M. 

Mu'riate  of  soda  or  common  salt  is  extensively  met  with  in  the 
inorganic  kingdom,  and  in  both  plants  and  animals.  Its  source, 
however,  as  an  article  of  commerce,  is  in  the  water  of  salt  springs, 
and  in  that  of  the  sea.  It  occurs,  too,  in  mines  in  various  parts  of  the 
world.  In  this  country,  the  chief  saline  springs  are  in  New  York, 
and  Virginia  ; the  salt  works  at  Kenawha,  in  the  latter  state,  being 
estimated  to  have  yielded  two  million  bushels  of  salt  in  the  year 
1835.  (Wood  & Bache.) 

Salt,  dug  from  the  earth,  is  sold  in  the  crude  state  under  the  name 
oi  rock  salt.  It  is  purified  by  solution,  and  crystallisation.  From 
sea-water,  it  is  made  in  the  same  manner,  the  evaporation  being 
either  accomplished  spontaneously,  or  by  heat.  Sea  water  contains 
about  2.25  per  cent,  of  it.  The  salt,  which  is  obtained  spontane- 
ously, is  the  BAY  SALT  : it  is  in  large  grains.  The  ordinary  saltis  pro- 
cured by  artificial  evaporation.  It  is  in  small  white,  irregular  grains  ; 
and  is  the  form  in  common  use.  Basket  salt,  is  common  salt  dis- 
solved and  recrystallised,  and  is  so  called  from  being  often  sold  in 
baskets.  This  and  the  bay  salt  are  the  best  qualities. 


JALAPA. 


191 


The  crystals  of  common  salt  are  white  cubes,  and,  when  pure,  they 
undergo  no  change  in  the  air  : as,  however,  it  generally  contains 
more  or  less  chloride  of  magnesium,  it  is  slightly  deliquescent.  At 
60°,  it  requires  about  two  and  a half  times  its  weight  of  water  to 
dissolve  it ; and  is  scarcely  more  soluble  in  boiling  water  than  in 
cold.  It  is  sparingly  soluble  in  rectified  spirit,  and  scarcely  at  all  so 
in  absolute  alcohol. 

Chloride  of  sodium  is  rarely  given  as  a cathartic,  although  in 
large  doses  it  acts  not  only  as  such,  but  as  an  emetic.  It  probably 
aids  the  action  of  the  other  cathartics  in  mineral  waters.  It  is  a 
very  common  addition  to  cathartic  enemata.  As  a cathartic,  it  ope- 
rates in  the  dose  of  ^ss  to  ^ij.  To  clysters  it  is  generally  added  in 
the  quantity  of  a table-spoonful  or  two. 

According  to  Sir  George  Lefevre,  chloride  of  sodium,  in  the  form 
of  brine,  in  which  cucumbers  are  preserved,  is  a most  popular  ape- 
rient in  Russia.  A small  watery,  seedy  cucumber  is  preserved  in 
salt  and  water,  to  which  a very  small  proportion  of  vinegar,  and 
some  leaves  of  the  black  currant  tree,  are  added.  Thousands  of 
barrels  are  so  prepared  annually,  and  serve  as  salad,  for  rich  and 
poor,  during  winter.  The  liquor,  impregnated  with  the  rind  of  the 
cucumber,  and  the  leaves  of  the  black  currant  tree,  is  drunk  in  doses 
of  a tumblerful,  and  seldom  fails  to  produce  the  desired  effect. 

Chloride  of  sodium  is  used  in  the  preparation  of  the  Hydrargyri 
Chloridum  mite  of  the  Pharmacopoeia  of  the  United  States. 

29.  MANGANE'Sir  SULPHAS.  _ SULPHATE  OF  MAN'GANESE. 

This  beautiful,  rose-coloured,  and  very  soluble  salt,  which  is  iso- 
morphous  with  sulphate  of  magnesia,  is  prepared  on  a large  scale 
for  the  use  of  the  dyer.  It  has  been  recently  recommended  by  Mr. 
A.  Ure  as  a cholagogue  cathartic.  If  a drachm  of  it,  he  says,  be 
dissolved  in  about  half  a pint  of  water,  and  swallowed  before 
breakfast,  it  will  generally  occasion,  after  the  lapse  of  an  hour  or  so, 
one  or  more  liquid  stools.  Infusion  of  senna  forms  a good  adjunct 
in  special  cases.  More  recently.  Dr.  Goolden  has  confirmed  the  ob- 
servations of  Mr.  Ure.  In  one  case,  the  immediate  effects  of  the 
salt  were  clearly  marked  in  producing  a copious  flow  of  bile, 
which  calomel  had  failed  to  do. 


III.  Drastic  Cathartics. 

30.  JALA'PA.  — JALAP. 

Jalap  root,  the  botanical  origin  of  which  was  long  uncertain,  is 
now  referred  to  Ipomae'a  jala'pa,  or  Ipomce'a  purga ; Sex.  Syst. 
Pentandria  Monogynia  ; Nat.  Ord.  Convolvulaceae  ; a plant,  which 
grows  on  the  mountainous  land  around  Chicanquiaco,  not  far  from 
Xalapa  or  Jalapa,  on  the  eastern  slope  of  the  Andes,  at  an  eleva- 
tion of  about  6000  feet.  Xalapa  is  the  only  market  for  the  drug, 


192 


SPECIAL  CATHARTICS. 


whence  it  is  exported  through  Vera  Cruz.  According  to  McCulloch, 
the  entries  of  jalap  into  England  for  home  consumption  amounted  at 
an  average,  in  1831  and  1832,  to  47,816  pounds  a year. 

Jalap  root  of  commerce  is  in  roundish  or  pyriform  masses,  rarely 
exceeding  a pound  in  weight,  and  varying  in  size  from  that  of  the 
fist  to  that  of  a hat.  The  tubers  are  often,  however,  cut  into  pieces 
or  sliced.  They  are  of  a dark  brown  colour,  rough  and  wrinkled 
externally;  heavy,  hard,  and  pulverisable  with  difficulty,  and  — 
when  broken  — of  a grayish  colour,  with  concentric  darker  circles, 
in  which  the  matter  is  denser  and  harder. 

Jalap  is  liable  to  be  worm-eaten,  but  it  has  been  found,  that  the 
insect  eats  only  the  amylaceous  portion,  so  that  what  remains  is 
stronger,  weight  for  weight,  than  that  which  has  not  been  touched 
by  it.  The  ^powder  — in  which  state  it  is  generally  seen  in  the 
shops  — is  of  a pale  grayish-brown  colour,  and  a very  disagreeable 
taste. 

The  active  properties  of  jalap  appear  to  reside  in  a resinous  sub- 
stance, which  exists  in  the  proportion  of  from  9 to  13.5  per  cent.  ; 
hence  water  takes  up  from  it  chiefly  amylaceous  and  mucilaginous 
extractive  matter,  and  little  of  the  cathartic  principle,  whilst  alcohol 
dissolves  the  resin. 

A LIGHT  or  FUSIFORM  JALAP,  Called  in  Mexico,  male  jalap,  and 
Said  to  be  the  produce  of  Ipoinas'a  Orizahen! sis,  is  sometimes  im- 
ported into  this  country,  mixed  with  the  true  jalap  ; or  alone,  and 
sold  for  the  latter.  The  genuine  drug,  may,  however,  be  known  by 
the  characters  above  described  : whenever  it  is  light,  of  a whitish 
colour  externally,  of  a dull  fracture,  and  spongy  or  friable,  it  ought 
to  be  rejected.  (Wood  & Bache.) 

Jalap  is  one  of  our  most  common  and  effective  cathartics.  It  is 
said  to  have  proved  fatal  by  the  violent  inflammation  it  induced  in 
the  gastro* enteric  mucous  membrane,  but  the  author  has  never  met 
with  such  a case.  It  augments  the  secretion  from  the  lining  mem- 
brane of  the  bowels,  and,  at  the  same  time,  greatly  increases  the 
peristaltic  action  ; to  a less  extent,  however,  than  gamboge.  It  is  given, 
however,  in  the  same  cases,  alone  or  associated  with  other  articles, 
where  it  is  desirable  to  exert  a considerable  revellent  and  depletive 
agency  on  the  intestinal  canal,  as  in  dropsy,  encephalic  affections, 
&c.  Whenever,  indeed,  a brisk  cathartic  is  needed,  jalap  fulfils  the 
indication.  It  is  apt,  however,  to  excite  nausea  or  tormina,  and 
hence  a corrigent,  as  ginger  or  some  other  excitant,  is  generally  added 
to  it ; or  another  cathartic,  which  may  modify  its  operation.  Jalap, 
associated  with  mild  chloride  of  mercury,  is  one  of  the  most  com- 
mon cathartics.  [Jalap,  pulv.  gr.  xv.  ; Hydrarg.  chlorid.  mit. ; 
Pulv.  Zingib.  aa  gr.  v.  — M.)  The  dose  of  powdered  jalap  is  from 
fifteen  to  thirty  grains.  Its  special  affinity  for  the  mucous  membrane 
of  the  bowels  is  exhibited  by  the  fact,  that  it  purges,  when  applied 
to  a wound.  To  children,  it  is  sometimes  given  in  cakes  of  ginger- 
bread, the  jalap  being  incorporated  with  the  paste. 


COLOCYNTHIS. 


193 


pulv.  5j.  ; potass,  bitart,  piilv.  ^ij.)  The  dose  of  this  powder  — 
which  is  a common  hydragogiie  cathartic  prescribed  in  dropsy,  and 
used  whenever  an  active  cathartic  is  demanded  — is  from  9j.  to  5j. 

TINCTU'RA  JALA'PiE,  TINCTURE  OP  JALAP.  — [Jalap,  pulv.  5viij  ; Alcohol, 
dilut.  Oij.  Prepared  either  by  maceration  or  by  the  process  of  dis- 
placement.) This  is  not  often  prescribed  alone.  It  is  usually  added 
to  cathartic  mixtures  to  quicken  their  operation.  As  a purgative,  it 
will  act  in  the  dose  of  f.  ^ij.  to  f.  ^ss. 

EXTRACTUl  JALA'PjE,  EXTRACT  OP  JALAP.  —Jalap,  in  pulv.  crass,  ; 
Alcohol.  Oiv.  ; Aqucc.^  q.  s.  — made  into  an  extract  by  the  process  of 
displacement.)  The  extract  may  be  given  in  doses  of  ten  grains  as 
a cathartic  ; but  it  is  rarely  used  alone.  It  is  an  ingredient  of  the 
PilulcB  catharticcE  compositce. 

Jalap-root  is  one  of  the  bases  of  the  Tinctura  Sennce  et  Jalapcc 
of  the  Pharmacopoeia  of  the  United  States. 

31.  UOLOCYN'THIS.  — COL'OCYNTH. 

The  colocynth  of  the  shops  is  the  fruit  of  Cucu'  mis  Colocyii’this., 
or  hitter  cu' cumber  ; Sex  Syst.  Monoecia  Syngenesia ; Nat.  Ord. 
Cucurbitacese — deprived  of  its  rind.  It  is  a native  of  Japan,  Coro- 
mandel, Cape  of  Good  Hope,  Syria,  Nubia,  Egypt,  Turkey,  and  the 
Islands  of  the  Grecian  Archipelago,  and  is  cultivated  in  Spain,  whence 
it  is  imported,  as  well  as  from  the  Levant,  Mogadore,  &c. 

The  quantity,  on  which  duty  was  paid  in  England,  in  the  year 
1839,  according  to  Dr.  Pereira,  was  10,417  lbs. 

The  fruit,  commonly  called  Coloquin' tida,  or  bitter  apple,  is 
gathered  in  autumn,  when  it  begins  to  assume  a yellow  colour,  and 
is  peeled  and  dried  quickly  either  in  the  sun  or  in  a stove.  It  is 
generally  imported  into  this  country  peeled,  but  sometimes  unpeeled 
— the  Turkey  colocynth  of  commerce  being  usually  peeled  — the 
Mogadore  unpeeled.  (Pereira.) 

The  colocynth  of  the  shops  is  in  whitish  balls  of  about  the  size 
of  a small  orange.  These  are  very  light  and  spongy;  the  seeds, 
which  are  inert,  constituting  three-fourths  of  their  weight.  The 
pith  is  the  officinal  portion.  It  has  not  much  smell,  but  its  taste  is 
intensely  and  enduringly  bitter  and  nauseous.  It  has  been  subjected 
to  analysis,  and  found  to  contain  a bitter  or  purgative  principle  — 
ColocynthUn  or  Colocynth' ite  — which  is  obtained  by  digesting  the 
watery  extract  in  alcohol,  and  evaporating  the  tincture  thus  formed. 
It  is  a bitter  resinoid  matter. 

The  pulp  of  colocynth  is  not  readily  pulverisable.  It  yields  its 
virtues  to  water  and  to  alcohol.  It  would  seem,  however,  that  cold 
water  takes  up  only  16  per  cent.,  whilst  boiling  water  takes  up  45 
per  cent. 

Colocynth  is  a powerful  irritant  to  the  mucous  membrane  of  the 
intestines,  exciting,  in  large  doses,  fatal  inflammation,  and,  as  one 
of  the  results  of  its  violence  of  action,  occasioning,  at  times,  abor- 
VOL.  I.  — 17 


194 


SPECIAL  CATHARTICS. 


tion  ; hence  it  has  been  used  to  induce  criminal  abortion,  which  — 
like  other  agents — it  never  accomplishes  except  through  the  violence 
it  does  to  the  system  of  the  mother.  Even  in  small  doses,  when  given 
alone,  its  operation  is  often  very  harsh,  and  hence  it  is  usually  com- 
bined with  other  articles  of  the  class.  It  seems  to  exert  its  ac- 
tion on  every  part  of  the  intestinal  canal,  and,  unlike  aloes,  excites 
the  organs  of  secretion  of  the  mucous  membrane  to  unwonted  ac- 
tion, and  thus  becomes  hydragogue  : as  such,  it  is  not  unfrequently 
prescribed  in  dropsy. 

The  dose  of  powdered  colocynth  is  from  five  to  ten  grains, 
intimately  mixed  with  powdered  gum  arabic  or  starch ; but  it  is 
rarely  given  in  this  state.  The  form  of  preparation,  most  com- 
monly prescribed,  is  the  following. 


21. 


EXTRAC  TS  COLOCYN'TniDlS  COMPOS'ITOI,  COMPOUND  EXTRACT  OF  COL'OCYNTH. 
(Colocynth.  Jvj  ; aloes^  pulv.  Jxij  ; scammon.  pulv.  ^iv ; cardamom. 
pulv.  jj  ; saponis,  jiij  ; alcohol,  dilut.  coug.)  The  aloes  and  scam- 
mony  are  added  to  modify  the  violent  action  of  the  colocynth ; the 
cardamom  corrects  the  griping  tendency  of  the  cathartics;  and  the 
soap  is  supposed  to  aid  their  solubility.  It  likewise  adds  to  the  con- 
sistency of  the  mass. 

Compound  extract  of  colocynth  or  cathartic  extract  is  an  excellent 
and  powerful  cathartic,  forming,  like  aloes,  the  basis  of  many 
extemporaneous  cathartic  pills.  It  is  very  often  associated  with 
the  mild  chloride  of  mercury,  and  forms  an  excellent  cathartic 
(Ext.  Colocynth.  comp.  5j’  ; hydrarg.  chlorid.  mit.  ^j.  — M.  et  divide 
in  pil.  xx.  Dose,  two  or  more,  at  bedtime.) 

The  ordinary  dose  of  compound  extract 
of  colocynth  as  a cathartic  is  from  five  to 
thirty  grains. 

PlL'llLiE  CATDAR'TICiE  COMPOS ITiE,  COMPOUND 
CATHAR  TIC  PILLS,  (Ext.  colocynth.  comp. 
pulv.  ^ss  ; extract,  jalap,  pulv.  ; hydrarg. 
chlorid.  mit.  aa  5iij  ; gambog.  pulv.  ^ij.  — 
M.)  This  combination  acts  effectively  in 
the  dose  of  three  pills.  Forms  for  cathar- 
tic pills  might,  however,  be  multiplied 
almost  indefinitely. 


32.  GAMBO'GIA.  — GAMBOGE. 

Gamboge  or  Camboge  — although  so 
well  known  as  a pigment  and  a drug  — 
is  the  concrete  juice  of  a tree  not  yet 
ascertained.  Two  kinds  of  gamboge 
1$  Fruit  hearing hrancii.  are  clesci'ibed  by  writers,  the  and 

I of  fruit  uiUi  its  four  ,,  n t i . •,  i i r.  jt 

+ i'nrnino-k  Unf  if  ihni  lilP 


IlebradcMiilroii  c.imbogio'ides. 

A.  IMalc  floweriiur  branch.  1.  Back 
view  of  I he  flower.  2.  Side  view 
of  the  calyx  :nid  column  of  tire 
stamens. 

Section 
seeds 


the  Ceylon.,  but  it  would  seem  that  the 
former  only  is  known  in  commerce. 
Although  uncertainty  hangs  on  the  precise  tree  or  trees  that  lurnish 


sc  AMMONIUM. 


195 


the  gaml30ge,  it  has  been  thought  to  be  obtained  from  Hehraden' dron 
Ca?nbogio'ides,  Cambo'gia  Gutta  or  Stalagmi'tis  Cambogio'ides, 
Sex.  Syst.  Monoecia  Monadelphia  ; Nat.  Ord.  Guttiferae,  a tree  of 
moderate  size,  which  is  a native  of  Ceylon ; and  it  is  inferred,  that 
in  Siam  it  is  procured  from  the  same  tree. 

Three  varieties  of  Siam  gamboge  are  met  with  in  commerce  ; 
1.  the  pipe,  so  called  in  consequence  of  its  being  in  cylinders,  often 
hollow  ; this  is  the  purest ; 2.  the  lump  or  cake,  in  masses  of  several 
pounds  weight,  containing  generally  fragments  of  wood,  twigs,  and 
air  cells  ; and  3.  the  coarse,  which  differs  from  the  other  in  contain- 
ing more  impurities. 

Pure  gamboge  is  devoid  of  -smell,  and  has  not  much  taste  ; but 
after  it  has  remained  some  time  in  the  mouth,  an  acrid  sensation  is 
experienced  in  the  fauces.  The  colour  of  its  fragments  is  orange 
yellow,  but  when  the  surface  is  rubbed  with  water,  it  becomes  a bright 
yellow,  — to  produce  which  it  is  extensively  employed  as  a pigment. 
It  is  brittle,  and  has  a smooth  glassy  conchoidal  fracture. 

Gamboge  has  been  carefully  analysed  by  Dr.  Christison,  who  found 
the  composition  of  the  pipe  variety,  according  to  two  analyses  of 
different  samples,  to  be  as  follows  : — Resin,  74.2,  — 71.6  ; arabin 
or  soluble  gum,  21.8,  — 24.0;  moisture  4.8  in  both  instances: 
total  — 100.8,  — 100.4.  It  contained  no  trace  of  volatile  oil. 

The  effect  of  gamboge  on  the  economy  is  like  that  of  elaterium, 
than  which,  however,  it  is  much  less  active  ; and,  like  it,  it  is  used 
whenever  a hydragogue  cathartic  is  needed,  as  in  dropsies,  encephalic 
diseases,  &c.  It  is  rarely  given  alone,  but  is  usually  associated  with 
other  cathartics,  which  mutually  temper  each  other’s  action.  Owing 
to  its  tendency  to  induce  nausea  and  vomiting,  it  should  be  prescribed 
in  small  doses,  — from  one  to  three  or  four  grains,  in  the  form  of  pill, 
repeated  every  four  or  five  hours.  It  is  one  of  the  ingredients  of  the 
Pilules  Calharticce  Composites  of  the  Pharmacopoeia  of  the  United 
States.  In  large  doses,  it  is  an  acrid  poison,  inducing  violent  in- 
flammation of  the  lining  membrane  of  the  stomach  and  bowels ; and 
the  deaths  which  have  followed  the  use  of  a celebrated  nostrum, 
Morrisords  Pills,  have  been  ascribed  to  it.  It  has,  indeed,  been  de- 
tected in  them. 

33.  SCAMMO'NIUM— SCAM'MONY. 

Scam'mony  is  the  concrete  juice  of  the  root  of  ConvoV vulus  Scam- 
mo'nia  or  Scammo'nea  ; Sex.  Syst.  Pentandria  Monogynia ; Nat. 
Ord.  Convolvulacese  ; a native  of  Greece  and  the  Levant.  It  is 
obtained  by  cutting  the  root  across  near  its  crown,  and  sticking  shells 
into  it  to  catch  the  juice  that  exudes.  The  root  is  very  large,  gene- 
rally three  or  four  inches  in  diameter,  and  as  many  feet  long  ; but  a 
single  root  yields  only  a few  drachms  of  scammony.  The  juice  is 
milky  as  it  exudes,  and  soon  concretes  under  exposure  to  air,  and 
evaporation. 

Scammony  is  usually  exported  from  Smyrna  ; occasionally,  it  goes 


196 


SPECIAL  CATHARTICS. 


by  way  of  Trieste,  and,  still  more  rarely,  is  shipped  from  Alexandria. 
The  finest  kind  is  called  Virgin  or  Lach'ryma  Scammony  ; other 
varieties  are  termed  seconds  and  thirds.  Formerly,  it  would  seem, 
the  term  Aleppo  Scammony  was  applied  to  the  finer,  and  that  of 
Smyrna  Scammony  to  the  inferior  kinds,  hut  no  such  distinction,  it 
is  said,  is  now  known  in  British  commerce.  In  1839,  the  quantity 
of  scammony  on  which  duty  was  paid  in  England  amounted,  accord- 
ing to  Dr.  Pereira,  to  8551  lbs. 

Scammony  is  said  to  be  so  generally  adulterated  that  it  is  not  easy 
to  fix  the  characters  of  the  genuine  article.  It  is  affirmed,  indeed, 
that  there  is  no  article  of  the  Materia  Medica,  which  is  sophisticated 
so  often,  or  which  it  is  so  difficult  to  find  pure,  even  in  mere  speci- 
mens for  scientific  examination.  Dr.  Christison  remarks,  that  spurious 
scammonies  are  so  very  common,  the  pure  drug  so  rare,  and  the 
characters  of  the  two  qualities  so  very  different,  that  he  has  known 
well  informed  retail-druggists  who  could  not  tell  what  the  pure  arti- 
cle was. 

The  following  have  been  laid  down  as  the  characters  of  good 
scammony  by  an  accurate  and  practised  observer.  Dr.  Pereira.  It 
readily  fractures  between  the  fingers,  or  by  the  pressure  of  the  nail ; 
its  specific  gravity  is  about  1.2  ; its  fracture  dark,  glistening,  and 
resinous  ; the  fractured  surface  should  not  effervesce  on  the  addition 
of  chlorohydric  acid,  which  it  would  do  if  chalk  were  present ; the 
decoction  of  the  powder,  filtered  and  cooled,  is  not  rendered  blue  by 
tincture  of  iodine,  which  it  would  be  if  starch  were  present.  One 
hundred  grains,  incinerated  with  nitrate  of  ammonia,  yield  about 
three  grains  of  ashes ; and  sulphuric  ether  separates  at  least  78  per 
cent,  of  resin  (principally),  dried  at  280°  F.  Such,  too,  are  mainly 
the  tests  of  purity  laid  down  in  the  last  Edinburgh  Pharmacopoeia. 
The  following  tabular  view  of  various  spurious  samples  of  scammony 
has  been  given  by  Dr.  Christison. 


Calcareous. 

Amyl: 

iceous. 

Calc.  Am. 

Resin, 

64.6 

56.6 

43.3 

37.0 

62.0 

42.4 

Gum, 

Chalk, 

6.8 

5.0 

8.2 

9.0 

7.2 

7.8 

17.6 

25.0 

31.6 

18.6 

Fecula, 

1.9 

4.0 

20.0 

10.4 

13.2 

Lignin  and  Sand, 

5.2 

7.1 

7.8 

22.2 

13.4 

9.4 

Water, 

6.4 

5.2 

6.4 

12.0 

7.5 

10.4 

Total, 

100.6 

100.8  101.3 

100.2 

100.5 

101.8 

Some  concrete  pieces,  obtained  from  various  species  of  convol- 
vulus, and  from  certain  species  of  the  Apocynaceae,  are  described  by 
writers  ; as  the  Montpel'ier  Scammony,  from  Cynan'chum  Monspel'ia- 
cum;  the  Bourbon  Scammony  from  Periylo'ca  Mauritia'na  ; and  the 
Germany  Scammony,  from  Convol' vulus  Se'pium  ; but  they  do  not 
appear  to  be  known  in  the  British  or  American  markets. 


OLEUM  TIGLII. 


197 


I 

Pure  scammony  is  a gum-resin,  containing,  however,  but  a small 
proportion  of  gum.  According  to  Dr.  Christison,  the  analysis  of  two 
distinct  specimens  gave  81.8  and  83.0  per  cent,  of  resin  ; 6.0  and  8.0 
of  gum  ; 1.0  and  0.0  of  starch  ; 3.5  and  3.2  of  fibre  and  sand  ; and 
7.7  and  7.2  of  water.  When  pure,  it  is  almost  wholly  soluble  in 
boiling  dilute  alcohol ; and  sulphuric  ether  takes  up  at  least  77  per 
cent.,  and  even  82  or  83  per  cent.,  if  the  specimen  be  tolerably  dry. 
The  resin  is  the  cathartic  principle,  and  is  separated  in  the  form  of  the 
Resina  sen  Extractum  Reammonii  of  the  Edinburgh  Pharmacopoeia. 

Scammony  is  a drastic  cathartic,  and  applicable  to  all  cases  in 
which  medicines  of  the  class  are  needed.  It  is  so  liable  to  adultera- 
tion, however,  and  so  uncertain,  withal,  in  its  operation,  sometimes 
acting  with  great  harshness,  that  it  is  not  much  used  in  this  country, 
and  when  it  is  so,  it  is  usually  in  combination  with  other  cathartics, 
whose  action  it  augments,  whilst  its  own  is  mitigated.  It  is  an  ex- 
pensive article,  costing  in  England  thirty-two  shillings,  or  about 
seven  dollars  per  pound,  wholesale. 

The  ordinary  dose  of  the  scammony  of  the  shops  is  from  five  to 
twenty  grains.  It  is  occasionally  prescribed  to  children  in  combina- 
tion with  mild  chloride  of  mercury,  and  an  aromatic  excitant  to  ob- 
viate its  griping  tendency.  [Scammon.  pulv.  gr.  iv.  ; Hydrarg, 
chlorid.  mil.  gr.  ij.  ; Zingib.  pulv.  gr.  iij.  M.)  It  maybe  made  into 
an  emulsion  with  milk,  which  diminishes  its  excitant  and  irritating 
• qualities. 

Scammony  enters  into  the  composition  of  the  Extractum  colocyn- 
thidis  compositum,  and  the  Rilulce  catharticce  compositce  of  the  Phar- 
macopoeia of  the  United  States. 

34.  O'LEUM  TIG'Lir.  — CROTON  OIL. 

Croton  oil  is  the  expressed  oil  of  the  seeds  of  Crotoii  Tig'lium  or 
Purging  Croton : Sex.  Syst.  Moncecia  Monadelphia  : Nat.  Ord. 
Euphorbiacese,  a native  of  the  continent  of  India,  and  of  the  islands 
forming  the  Indian  Archipelago  and  Ceylon,  'fhe  seeds,  formerly 
called  Grana  tigl'ii^  G.  til'ii^  G.  Moluc'ccx^  &c.,  are  in  size  and  shape 
similar  to  those  of  the  castor  oil  plant.  The  shell  is  "covered  with  a 
yellowish  epidermis,  beneath  which  the  surface  is  dark  brown  or 
blackish.  The  kernel  is  of  a yellowish  brown  colour,  and  forms 
about  64  per  cent,  of  the  seed.  The  seeds  are  imported  with  the 
view  of  obtaining  the  oil  from  them,  of  which  they  yield  about  50 
per  cent,  under  strong  pressure.  They  have  beeti  repeatedly  sub- 
jected to  analysis,  but  no  important  pharmaceutical  information  has 
accrued  from  it. 

The  oil  is  obtained  from  the  seeds  in  the  same  manner  as  the 
Oleum  Ricini  from  the  seeds  of  Ricinus  Communis.  It  would  seem, 
likewise,  to  be  obtained  from  the  seeds  of  Croton  Pava^na,  a native 
of  Ava  ; and  Dr.  Burrough,  who  was  for  some  time  in  India,  in- 
formed Dr.  Wood,  that  much  of  the  oil,  prepared  there  for  exporta- 
tion, is  derived  from  the  seeds  of  a plant  entirely  different  from  croton 

17# 


198 


SPECIAL  CATHARTICS. 


liglium.  A parcel  of  these  seeds  was  planted  by  Dr.  R.  E.  Griffith, 
who  succeeded  in  raising  a plant,  which  proved  to  be  Ja’tropha 
Curcas^  the  seeds  of  which  are  known  by  the  name  of  Barbadoes 
JVuts.  This  oil  is  weaker  than  the  real  croton  oil,  but  is  said  by 
Ur.  Burrough  to  be  an  efficient  cathartic  in  the  dose  of  three  or  four 
drops. 

Croton  oil  is  a thickish  fluid,  of  a honey-yellow  colour,  disagree- 
able smell,  and  very  acrid  taste,  exciting  inflammation  of  the  tongue 
and  fauces.  It  has  a very  acrid  matter  associated  with  it,  possessing 
acid  qualities  — the  crotonic  acid  — which  is  identical  with  the  jatro- 
phic.  In  ether  and  turpentine  it  is  wholly  soluble  ; in  alcohol  par- 
tially so. 

It  is  occasionally  adulterated  with  castor  oil,  which  may  be  de- 
tected by  treating  it  with  absolute  alcohol,  which  dissolves  the  castor 
oil,  and  thus  lessens  the  volume  of  the  oil,  whilst  no  perceptible  effect 
is  produced  on  pure  croton  oil. 

Croton  Seeds,  like  the  seeds  of  the  castor  oil  plant,  are  highly 
acrid  and  cathartic.  In  India  they  are  prepared  for  medical  use  by 
being  slightly  torrefied,  by  which  the  shell  is  more  readily  separable, 
and  the  activity  of  the  acrid  property  thought  to  be  diminished. 
Even  then  the  kernel  acts  powerfully  as  a cathartic  in  the  dose  of 
one  or  two  grains. 

Croton  Oil  is  a drastic  cathartic,  very  valuable  in  one  respect 
— that  it  can  be  given  in  small  doses.  In  many  cases  of  great  tor- 
por of  the  intestines,  its  action  has  proved  very  certain.  Even  a drop 
commonly  produces  eight  or  ten  fluid  evacuations  ; but  at  times  it 
has  been  necessary  to  give  as  many  as  four  or  five  drops  in  the  course 
of  ten  or  twelve  hours.  Like  most  of  the  drastic  cathartics,  it  occa- 
sions tormina,  but  these  are  less  distressing  than  the  burning  sensa- 
tion which  it  commonly  causes  in  the  fauces.  Not  unfrequently,  also, 
it  induces  nausea  and  vomiting.  It  is  one  of  the  most  speedy  ca- 
thartics in  its  operation,  and  being  active  in  a small  dose,  it  is  adapted 
for  cases  in  which  deglutition  is  effected  with  difficulty  or  is  imprac- 
ticable, as  in  apoplexy,  paralysis,  &c.,  in  which  cases  it  may  be 
dropped  on  the  tongue.  It  may  likewise  be  employed  when  a re- 
vellent  action  on  the  bowels  is  needed,  or  in  obstinate  constipation 
where  other  remedies  have  failed. 

The  ordinary  dose  is  stated  to  be  one  or  two  drops  ; but  it  will 
generally  operate  in  smaller  quantity  than  this,  even  in  one-fourth  or 
one-half  a drop,  repeated  every  hour  or  two.  It  is  usually  given  in 
the  form  of  pill.  ( Olei  tiglii,  gtt.  iv  ; Micce  panis  q.  s.  ut  ft.  pil.  viij. 
Dose,  one,  two,  or  more.)  It  has  also  been  given  in  the  form  of 
emulsion^  the  objection  to  which  is  the  acrid  sensation  it  induces  in 
the  throat.  Hufeland  recommended  it  as  a substitute  for  castor 
oil,  advising  that  a drop  of  it  should  be  added  to  an  ounce  of  oil 
of  poppies,  and  that  the  mixture  should  be  called  O'leum  Ric"mi 
qfficina'le. 


ELATERIUM. 


199 


A soap  of  Croton  oif  composed  of  two  parts  of  the  oil  to  one  part 
of  liquor  potassse,  has  been  recommended,  of  which  two  or  three 
grains  prove  cathartic. 

A Tincture  of  the  seeds  has  likewise  been  proposed,  formed  of  two 
ounces  of  the  seeds  from  which  the  rinds  have  been  removed,  and 
one  ounce  of  alcohol.  This  acts  as  a cathartic  in  the  dose  of  20 
drops. 

Croton  oil  — as  will  be  seen  under  another  head  — is  likewise  a 
valuable  counter-irritant;  and  it  is  affirmed,  that  a few  drops,  ap- 
plied externally  by  way  of  friction  around  the  umbilicus,  have  ex- 
erted a cathartic  effect.  In  obstinate  cases,  or  where  the  stomach 
will  not  readily  receive  this  or  other  purgatives,-  it  may  be  tried  in 
this  manner. 

In  another  work,  {JYew  Remedies^  4th edit.  p.  468.  Philad.  1843), 
the  author  has  given  various  forms  for  administering  the  croton  oil, 
many  of  which,  however,  are  employed  by  individuals  rather  than 
by  the  mass  of  the  profession. 

35.  O'LEUM  EUPHOR'BI^  LATHYR'IDIS.  — OIL  OF  CAPER  SPURGE. 

Euphor'hia  Lath'yris^  Garden  Spurge,  Caper  Spurge^  Caper 
plant  or  Mole  plant ; Sex.  Syst.  Dodecandria  Trigynia  ; Nat.  Ord. 
Euphorbiaceae,  is  indigenous  in  France.  Although  not  a native  of 
this  country,  it  is  sometimes  met  with  in  situations  where  it  has  the 
appearance  of  growing  wild.  It  is  easily  cultivated,  and  in  some 
parts  of  New  Jersey  is  found  in  abundance.  The  oil  is  obtained 
from  the  seeds  in  the  same  manner  as  castor  oil  from  the  castor  oil 
seeds.  It  resemble.s,  in  colour,  the  Oleum  Ricini,  but  is  less  dense. 
It  has  no  odour  when  newly  prepared,  and  no  perceptible  taste  ; but 
it  speedily  becomes  rancid  and  acquires  great  acrimony.  It  is  solu- 
ble in  sulphuric  ether;  insoluble  in  alcohol,  and  forms  a soap  with 
alkalies. 

About  forty  or  forty-four  parts  of  oil  are  obtained  by  expression 
from  one  hundred  parts  of  the  seeds. 

The  oil,  prepared  in  Europe,  acts  as  a cathartic  in  the  dose  of 
from  four  to  eight  drops,  without  occasioning  tormina  or  tenesmus, 
but  that  obtained  from  beans  raised  in  this  country  is  not  as  mild 
an  article.  Even  when  administered  with  aromatic  oils,  and  made 
into  a soap  with  alkalies,  it  produced,  in  numerous  instances,  nausea 
and  vomiting.  It  would  seem,  however,  that  when  given  in  small 
quantities,  and  repeated  at  intervals  of  half  an  hour  or  an  hour,  it 
operates  freely  as  a cathartic  without  inducing  much  nausea. 

It  may  be  given  in  the  form  of  pill  with  crumb  of  bread,  or 
made  into  an  emulsion  with  mucilage  of  gum  arabic,  sugar,  and 
wmter. 

36.  ELATE'RIUM. 

Elaterium  is  a substance  deposited  by  the  juice  of  the  fruit  of 


200 


SPECIAL  CATHARTICS. 


Momor'dica  Elate'rium^  Wild  or  Squirting  Cu'cumber ; Sex.  Svst. 

Moncecia  Syngenesia  ; Nat.  Ord. 
Cucurbitacese,  a native  of  the 
South  of  Europe,  and  common 
on  rubbish  in  the  villages  of 
Greece,  and  the  Archipelago. 
It  is  cultivated  in  Great  Britain 
for  medical  use. 

It  was  found  by  Dr.  Clutter- 
buck,  that  the  seat  of  elaterium  is 
entirely  in  the  juice  around  the 
seeds,  obtained  without  expres- 
sion. When  the  cucumber  is 
sliced  and  placed  upon  a sieve, 
a colourless  juice  flows  out,  which 
soon  becomes  turbid,  and  in  a 
few"  hours  deposites  a sediment. 
This  is  the  true  elaterium,  which 
Dr.  Clutterbuck  found  to  purge 
in  the  dose  of  one-eighth  of  a 
grain.  The  quantity,  how^ever, 
obtained  in  this  way,  is  very 
small,  not  more  than  six  grains 
having  been  got  from  forty  cu- 
cumbers. The  process  recom- 
mended in  the  British  Pharmaco- 
poeias is  to  slice  ripe  wild  cucum- 
bers and  strain  the  juice,  very 
gently  expressed,  through  a very 
fine  hair-sieve,  it  is  then  set  by  for  some  hours,  until  the  thicker  part 
has  subsided.  The  thinner  supernatant  part  being  rejected,  the 
thicker  is  dried  with  a gentle  heat.  It  would  appear,  however,  that 
the  process,  actually  follow"ed  at  Apothecaries’  Hall,  London,  is  the 
following  : — The  fruits  are  cut  longitudinally  in  halves  by  women, 
and  are  then  placed  in  a hempen  cloth,  and  put  into  a screw-press  ; 
apparently,,  a tolerable  pressure  is  applied,  but  for  a few  minutes 
only,  being  removed  before  all  the  juice  has  ceased  to  run  out. 
When  the  fruits  are  taken  out  of  the  press,  they  are  but  very 
slightly  crushed,  so  that  the  pressure  cannot  have  been  great.  The 
juice — as  it  runs  from  the  press — falls  into  a hair-sieve,  through 
which  it  flows  into  a cylindrical-lipped  glass  jar.  Here  it  is  allow’ed 
to  remain  for  about  tw^o  hours,  in  which  time  a greenish  fecula  is 
deposited.  The  supernatant  liquor  is  then  carefully  poured  off, 
and  the  thicker  liquid  at  the  bottom  is  placed  on  a paper  filter  sup- 
ported by  a cloth  one,  stretched  on  a wooden  frame  ; a bitter,  yel- 
lowish-brown liquor  runs  through,  and  a green  mass  is  left  on  the 
lilter.  The  latter  is  then  carefully  dried  by  a stove,  and  constitutes 


Fif?.  22. 


Momorilica  Elaterium. 
a.  Pepo  expelling  its  seeds;  h.  Stalk;  c. 
Transverse  section  of  the  pepo.  (Pereira.) 


ELATERIUM. 


201 


the  finest  elaterium.  The  mother  liquid,  which  was  poured  off  from 
the  deposit,  is  placed  in  shallow  brown  pans,  and  there  lets  fall  a 
fresh  deposit,  which,  when  separated  and  dried,  forms  paler  elate- 
rium. 

Elaterium  of  commerce  appears  to  consist  essentially  of  the  active 
matter,  to  which  the  name  elaterin  has  been  given,  with  the  green 
colouring  matter,  cellular  tissue,  and  starch  expressed  from  the  fruit, 
and  mixed  with  the  residue  obtained  by  drying  the  bitter  liquor,  with 
which  the  tissues  and  elaterin  were  moistened.  It  is  in  light,  thin, 
friable  cakes  or  segments,  which  bear  frequently  the  marks  of  the 
muslin  or  paper  on  which  they  were  dried.  The  colour  is  of  a pale 
greenish  gray,  which  becomes  yellowish  by  exposure.  Its  taste  is 
acrid  and  bitter. 

Some  inferior  kinds  are  met  with,  which  are  much  curled,  gummy, 
and  of  a brown,  or  olive  green  colour.  They  are  supposed  to  be 
prepared  from  the  jui6e  after  the  finest  elaterium  has  been  separated. 

A variet}/  of  elaterium  is  imported  into  England  from  Malta,  which 
is  in  much  larger  flakes  than  the  best  English  elaterium,  and  has 
frequently  some  paper  adherent  to  it  on  which  it  was  dried.  It  is 
not  seen,  so  far  as  the  author  knows,  in  this  country. 

So  active  a substance,  and  one  so  liable  to  variation  in  strength, 
not  so  much  from  adulteration  as  from  errors  in  the  time  of  collecting 
or  mode  of  preparation,  has  necessarily  attracted  to  it  the  attention 
of  the  chemical  analyst.  Dr.  Paris  found  100  parts  to  contain  26 
per  cent,  of  extractive  ; 28  of  starch ; 5 of  gluten  ; 25  of  woody 
matter  ; 4 of  water,  and  12  of  a green,  resinoid  and  bitter  matter, 
to  which  he  gave  the  name  Elatin  ; and  as  he  ascertained,  that  it 
possessed  all  the  properties  of  the  elaterium,  he  considered  it  to  be 
the  active  principle.  Since  then,  however,  this  elatin  has  been 
shown  to  consist  of  chlorophylle  or  green  colouring  matter,  with  a 
colourless  crystallisable  substance,  to  which  the  name  Elaterin  has 
been  given. 

The  following  table,  from  Pereira,  exhibits  the  different  strength  of 
various  specimens  of  elaterium  : 


100  parts  of  Elaterium.  Quantity  of  Elaterin. 

Prepared  according  to  the  London  College, 

[Hennell,)  -----  44 

Best  British  Elaterium,  (Morries,)  - - - 26 

Worst  do.,  (Morries^)  - - - - 15 

French  Elaterium,  (Morries^)  - - - 5 or  6 

Elaterium,  {Edinburgh  Pharmacopoeia^)  - - 14,  3 to  25 

Best  specimens,  {Balmer,)  - - - - 33 

Fine  sample,  prepared  at  Apothecaries’  Hall  in 

1839,  and  dried  by  steam  heat,  {Pereira^)  - 26 


Elaterium,  in  an  over-dose,  is  a violent  acrid  poison,  producing 
inflammation  of  the  lining  membrane  of  the  stomach  and  bowels.  In 


202 


SPECIAL  CATHARTICS. 


smaller  doses,  it  is  a drastic  cathartic,  causing  a copious  secretion 
from  the  follicles  and  exhalants  of  the  intestines,  and  being  the  most 
active  of  the  hydragogue  cathartics.  On  this  account  it  is  employed 
in  dropsy ; and,  where  there  has  been  no  important  lesion  of  the  ab- 
dominal viscera,  its  revellent  and  depletive  influence,  exerted  in  this 
mariner,  has  succeeded  in  cases  of  active  dropsy,  after  other  remedies 
had  failed.  By  its  revellent  action;  it  is  likewise  well  adapted  for 
encephalic  affections,  such  as  apoplexy,  mania,  &c.,  in  which  there 
is  usually  great  torpor  of  the  intestines. 

On  account  of  the  uncertainty  of  the  strength  of  commercial  elate- 
rium,  and  the  occasional  harshness  of  its  operation,  it  is  not  much 
employed,  and  when  it  is,  it  should  be  given  in  divided  doses,  and 
be  repeated  until  it  operates.  Half  a grain,  united  with  three  grains 
of  the  extract  of  gentian  as  a constituent,  may  be  given  every  hour 


Fig  2.3. 


A{)r)cyiiijin  canniliimiin. 


one-eighth  of  a grain  ; that  of  the 
twelfth  of  a grain. 


or  two,  until  it  operates.  Even 
in  this  quantity,  it  may  excite 
nausea  and  vomiting.  Not  un- 
frequently,  it  acts  on  the  bowels 
in  the  dose  of  one-eighth  and 
even  of  one-sixteenth  of  a grain. 
The  ordinary  dose  of  good  ela- 
terium  may,  indeed,  be  so 
stated,  yet  we  rarely  meet  with 
it  of  such  a strength.  I)r.  Pe- 
reira affirms,  that  he  has  repeat- 
edly employed,  and  seen  others 
employ,  elaterium,  and  has  al- 
ways observed,  that  a quarter 
of  a grain  of  good  elaterium 
acted  very  powerfully,  some- 
times bringing  away  several 
pints  of  fluid  ; and  that  half  a 
grain  usually  occasioned  vomit- 
ing as  well  as  violent  purging. 

As  the  active  part  of  elate- 
rium, the  eluterin  is  soluble  in 
rectified  spirit,  it  has  been  pro- 
posed to  administer  it  in  the 
form  of  tincture,  made  of  one 
grain  of  elaterin^  a fluidounce 
of  alcohol^  and  four  drops  of  ??^- 
tric  acid.  Between  thirty  and 
forty  minims  seldom  fail  to  act 
freely. 

The  dose  of  the  elaterium  of 
Clutterbuck  is  always  fixed  at 
elaterin  at  one-sixteenth  to  one- 


ELATERIUM. 


203 


Some  other  indigenous  articles  that  act  as  cathartics  have  been 
admitted  into  the  secondary  list  of  the  Pharmacopceia  of  the  United 
States  ; for  example  : 


37.  Apoc"ynum  cANNAs'iNUivf,  Indian  Het?ip  : Sex.  Syst.  Pentandria 

Digyhia  ; Nat.  Ord.  Apocynacem:  the  root  of  which  is  officinal,  and 
which  is  powerfully  emetic  and  cathartic.  It  has  been  used  as  a hy- 
dragogue  cathartic  in  dropsy.  From  fifteen  to  thirty  grains  of  the  pow- 
dered root  generally  induce  vomiting.  It  is  most  commonly  given 
in  decoction.  [Apocyn.  cannah,  giss  ; Aqux^  Oiss  ; coque  ad  Oj.  — 
Dose,  f.  3j.  to  3ij.)  , 

38.  Convol'vulus  pandura'tus,  Wild pota'to^  Sex.  Syst.  Pentan- 
dria Monogynia  ; Nat.  Fig.  24. 

Ord.  Convolvulacese, 
which  grows  in  ^ every 
part  of  the  United,*States, 
flowering  from  .June  to 
August.  The^ot,  which 
is  the  officinal  portion,  has 
been  proposed  as  a sub- 
stitute for  jalap  in  the  dose 
of  forty  grains,  but  it  is 
rarely  employed. 

39.  Iris  versi'color, 

Blue  flag:  Sex.  Syst.  Tri- 
andria  Monogynia ; Nat. 

Ord.  Iridacese  ; found  in 
all  parts  of  the  United 
States,  flowering  in  June ; 
the  root  of  which  — the 
officinal  portion  — has 
been  used  as  a cathartic  ; 
but  it  is  apt  to  be  followed 
by  distressing  nausea  and 
prostration.  The  dose  is 
from  twenty  to  thirty 
grains,  but  it  is  scarcely 
ever  employed. 

40.  Trios'teum,  Fever- 
root.  This  is  the  root  of  yii 
Trios’teum  perfolia’tum ; Jj 

Fever-root j Feverwort  or  * convolvulus  panduratus. 


Wild  Ip'ecac.;  Sex.  Syst.  Pentandria  Monogynia;  Nat.  Ord.  Capri- 
foliacece  ; which  is  found  in  most  parts  of  the  United  States  ; flowering 
in  June.  The  root  is  cathartic  ; and  in  large  doses  emetic.  The  dose 
of  the  bark  of  the  root  — tlie  part  usually  employed  — is  twenty  or 
thirty  grains ; alone  or  combined  with  other  cathartics,  as  calomel. 


204 


AxNTliELMINTICS. 


III.  ANTHELMIN'TICS. 

St  NON.  ^Intithelmintica,  Anliscolica^  Anlivermmosa,  Verniifug^es. 

Definition  of  anthelmintics — Experiments  on  worms,  out  of  the  body — Difterent  kinds 
of  anthelmintics — True  anthelmintics — Mechanical  anthelmintics — Anthelmintics 
that  expel  worms  by  acting  on  the  intestinal  canal — Anthelmintics  that  prevent  the 
formation  of  worms — Ectozoa — Special  anthelmintics. 


This  class  of  medicinal  agents  ought  to  embrace  not  only  medi- 
cines, which  prevent  the  generation  of  entozoa  within  the  body,  but 
such  as  destroy  or  expel  them,  when  already  existing  there. 

The  common  definition  of  anthelmintics  is — remedies  which  de- 
stroy or  expel  worms  situate  in  any  part  of  the  alimentary  canal.” 
Murray  and  Paris  restrict  it  to  “ remedies,  which  expel  worms  — 
but  this  is  an  unimportant  part  of  their  operation.  The  great  object 
is  to  get  rid  of  the  predisposition  to  their  generation.  The  anthel- 
mintics, that  destroy  or  expel,  merely  remove  the  parasites  already 
present  in  the  alimentary  tube  ; but,  unless  the  pathological  condition 
that  gives  occasion  to  their  reproduction  is  removed,  the  evil  will 
constantly  recur. 

Whilst  this  pathological  condition  was  disregarded,  attempts  were 
altogether  restricted  to  the  discovery  of  such  agents  as  appeared  to 
be  detrimental  to  entozoic  existence,  or  of  such  as  might  most  ef- 
fectually dislodge  the  parasites ; and  the  number,  brought  forward 
with  such  pretensions,  has  been  prodigious  ; yet  but  few  are  em- 
ployed at  the  present  day,  and  this  partly  — indeed  chiefly- — be- 
cause the  main  object  of  the  practitioner  is  properly  considered  to 
be  to  prevent  their  fresh  generation. 

Numerous  experiments  have  been  instituted  on  worms,  that  have 
been  voided,— under  an  expectation,  that  some  light  might,  in  this 
way,  be  thrown  on  the  agents  that  would  probably  be  most  detrimental 
to  them  whilst  in  the  body.  Redi  undertook  several  experiments  on 
the  ascarides  lumbricoides,  of  which  the  following  is  a partial  sum- 
mary : — in  cold  water ^ they  lived  from  sixty  to  seventy  hours ; in  an 
infusion  of  coralline^  more  than  sixty  hours ; more  than  thirty  in 
water  rendered  bitter  by  aloes ; in  water  saturated  with  salt^  they 
died  speedily;  in  brandy^  still  more  speedily;  in  syruj)  — and  the 
experiment  was  often  repeated  — within  three  or  four  hours.  In 
wine^  one  lived  twenty-four,  another  forty,  and  a third  seventy-four 
hours. 

It  has  been  a question,  whether  the  fatty  oils  be  noxious  to  worms. 
They  who  believe,  that,  like  insects^  they  are  furnished  with  spira- 
cula,  have  thought,  that,  by  pouring  oil  upon,  or  anointing  them,  the 
spiracula  would  become  obstructed,  and  hence  the  animal  would  die. 
Human  entozoa  are  not,  however  furnished  with  spiracula,  nor  do 
experiments  prove  the  noxious  agency  of  oils.  Coulet  affirms,  that 
he  found  the  tsenia  solium  live  as  long  in  oil  of  almonds  as  in  any 
other  fluid.  Arnemann,  found  that  human  ascarides  lumbricoides. 


TRUE  ANTHELMINTICS. 


205 


as  well  as  those  of  the  swine,  lived  several  days  in  oz7,  when  kept 
in  a warm  situation.  They  were  in  all  cases,  however,  affected 
with  restlessness  and  contortions  ; but  their  bodies  became  gradually 
languid  and  lax  ; their  movements  were  executed  with  difficulty,  and, 
as  it  appeared,  painfully,  and  the  skin  was  contracted  into  rugse.  In 
oil  of  sweet  almonds^  a lumbricus  of  the  hog  lived  twenty-seven 
hours  ; another  thirty ; human  lumbrici,  from  forty-six  to  fifty-three. 
In  oil  of  hitter  almonds^  the  lumbrici  of  the  hog  lived  eighteen, 
twenty-four,  and  thirty-nine  hours  ; whilst  the  human  died  within 
thirty- four.  In  castor  oil,  those  of  the  hog  lived  fifty-six  ; the  human, 
from  forty-four  to  forty-eight ; the  distoma  hepaticum,  eight.  In  lin- 
seed oil,  those  of  the  swine  from  eighteen  to  twenty  ; the  human  from 
twenty-three  to  twenty-six.  In  oil  of  walnuts,  those  of  the  swine, 
twenty-two  ; the  human,  twenty  to  twenty-five.  In  oil  of  the  hazel- 
nut, those  of  the  hog,  nineteen  ; the  human,  twenty-six.  In  oil  of 
poppy,  those  of  the  hog,  twenty  ; the  human,  seventeen,  twenty-two, 
and  twenty-seven.  In  oil  of  elder,  those  of  the  hog,  twenty-eight ; 
the  human,  two  and  three.  In  oil  of  hyoscyamus,  those  of  the  hog, 
eighteen  and  twenty-two  ; the  human,  twenty-seven.  In  oil  of  beech, 
those  of  the  hog  from  twenty-nine  to  thirty-two  ; the  human,  forty 
to  forty-six.  In  oil  of  hemp,  those  of  the  hog,  sixteen  and  twenty- 
three  ; the  human,  twenty-seven.  In  oil  of  mustard,  both  those  of 
the  hog,  and  man,  thirty-six.  In  rape  oil,  those  of  the  hog,  twenty- 
one  to  twenty-six  ; the  human,  twenty-eight ; and  in  oil  of  behen  the 
human  lived  twenty-six  hours. 

None  of  these  experiments,  however,  were  as  satisfactory  as  those 
instituted  by  Chabert  with  his  empyreumdtic  oil,  which  consists  of 
one  part  of  the  fetid  or  empyreumatic  oil  of  hartshorn,  and  three  of 
the  essential  oil  of  turpentine,  subjected  to  distillation.  Every  kind 
of  worm,  immersed  in  it,  was  killed  either  immediately,  or  after  the 
lapse  of  a few  minutes.  The  preparations  of  turpentine  are,  indeed, 
amongst  the  most  detrimental  to  entozoic  existence  of  the  substances 
with  which  we  are  acquainted. 

Anthelmintics,  according  to  the  definition  generally  given  of  them 
at  the  present  day,  may  be  divided  into  four  classes. 

First,  — True  anthelmintics.  Secondly,  — Mechanical  anthelmin- 
tics. Thirdly,  — Anthelmintics,  that  expel  worms  by  acting  on  the 
intestinal  canal.  Fourthly,  — Anthelmintics,  that  prevent  their  for- 
mation. 

1 . True  Anthelmintics. 

Of  those  anthelmintics,  that  prove  destructive  to  entozoic  life  by 
virtue  of  some  principle,  poisonous  to  them,  which  they  contain, 
there  are  but  few  employed  in  ordinary  practice  ; yet  the  lists  of  the 
materia  medica  supply  us  with  a host  of  such  remedies.  The  pre- 
parations of  turpentine,  especially  the  oil,  united,  or  not,  with  the 
empyreumatic  animal  oil  obtained  during  the  distillation  of  harts- 
horn, are  decidedly  the  best ; but  the  improvident  employment  of 
VOL.  I. — 18 


206 


ANTHELMINTICS. 


these  and  other  excitant  agents  is  liable  to  induce  that  debility  of 
tne  digestive  function  and  of  the  system,  which  is  the  great  predis- 
ponent  of  worms. 

If  the  proper  administration  of  these  remedies  fails  to  destroy  the 
parasites,  little  dependence  can  be  placed  upon  the  others. 

It  is  singular,  that  M.  H.  Cloquet  should  put  the  aqueous  decoction 
of  hydrargyrum  purificatum  at  the  head  of  his  list  of  anthelmintics. 
He  observes,  also,  that  he  has  seen  the  ascarides  lumbricoides  eva- 
cuated in  a state  of  torpor,  after  the  abdomen  of  the  patient  had  been 
rubbed  with  a mixture  of  ox'‘s  gall^  and  common  soap,  with  oil  of 
tansy,  or  oil  of  chamomile,  strongly  impregnated  with  camphor,  and 
garlic;  or  with  milk,  holding  aloes  in  solution,  impregnated  with  the 
bitter  principle  of  the  colocynth,  and  camphor ; or  with  a maceratum 
of  bruised  garlic  in  camphorated  sulphuric  ether.  A like  effect,  he 
says,  is  produced  by  a plaster  composed  of  yellow  wax,  litharge, 
assafeiida,  and  galbanum.  He  also  recommends  an  application, 
which  is  neither  the  most  elegant,  nor  readily  attainable;  — assafetida 
dissolved  in  the  gastric  juice ! “ or,  what  is  more  simple,  in  the 
saliva!'^'’  Other  external  applications  have  been  recommended  by 
Laennec,  Barton,  &c.;  their  action,  however,  may  in  all  cases  be 
explained  in  one  of  two  ways.  The  terebinthinate,  alliaceous,  or 
highly  odorous  agents  may  be  absorbed  into  the  system,  and,  in  this 
way  come  in  contact  with  the  entozoa,  but  it  is  not  probable,  that 
they  can  affect  them,  in  a state  of  sufficient  concentration,  to  be 
detrimental.  This  explanation  will  not,  however,  apply  to  others. 
There  is  every  reason  for  believing,  that  frictions,  cataplasms  &c., 
act  as  indirect  anthelmintics  only,  by  improving  the  activity  of  the 
gastric  and  intestinal  operations,  and  thus  removing  the  grand  pre- 
disposition. 

2.  Mechanical  Anthelmintics. 

Of  these,  two  only  are  now  in  general  use.  In  the  United  States, 
indeed,  neither  of  these  is  much  employed,  but  in  Great  Britain  they 
have  by  no  means  outlived  favour.  These  two  are  the  Jilwgs  of  tin 
or  granular  tin,  and  mucuna  or  cowhage.  The  mode  in  which  they 
act  is  described  hereafter. 

3.  Anthelmintics  that  expel  worms  by  acting  on  the  intestinal  canal. 

The  substances  that  operate  in  this  manner  belong  to  the  class  of 
cathartics;  but  these  should  not  be  of  a violent  character,  or  often 
repeated,  owing  to  the  debility  they  are  likely  to  induce  in  the  di- 
gestive organs.  The  occasional  exhibition  of  a brisk  cathartic  is 
often  a valuable  agency  not  only  in  removing  the  worms,  but  in  sti- 
mulating the  gastric  function  to  a more  healthy  action,  and  thus  re- 
moving the  predisposition.  By  exciting,  too,  the  intestines  to  throw 
off  the  retained  faeces,  and  secretions,  — in  which  the  worms  are  often 
enveloped,  and  find  a nidus  favourable  for  their  generation, — they 
enable  those  anthelmintics,  which  may  be  prescribed,  to  come  more 


ANTHELMINTICS. 


207 


immediately  into  contact  with  the  parasites,  and  should,  consequently, 
be  made  to  precede  the  use  of  those  remedies.  Nor  is  it  alone  prior 
to  the  administration  of  anthelmintics  that  cathartics  are  useful. 
When  the  former  have  been  prescribed  for  a few  days,  and  there  is 
reason  to  hope  that  they  have  occasioned  the  death  of  the  worms,  a 
brisk  cathartic  may  be  advantageously  given  for  the  purpose  of  re- 
moving any  accumulation  of  dead  animal  matter  that  may  have  taken 
place,  and  thus  of  diminishing  the  tendency  to  a fresh  generation. 
The  cathartics  that  have  been  chiefly  used  for  this  purpose,  are 
oleum  ricini^  oleum  tiglii^  gamboge ^ scammony,  jalap ^ aloes ^ and  calo- 
mely  — singly  or  combined. 

4.  Anthelmintics  that  prevent  the  formation  of  worms. 

This  class  of  agents  is,  after  all,  the  most  important.  The  great 
predisposition  to  invermination  consists  in  want  of  tone  generally, 
and  of  the  gastro-enteric  organs  especially.  Accordingly,  agents 
that  are  found  to  aid  chylosis,  prove  most  valuable.  Charcoal  has 
long  had  a character  for  being  anthelmintic,  and  it  is  well  known, 
that  it  has  been,  and  is,  constantly  mixed  with  the  food  employed 
for  fattening  fowls  for  the  markets  of  large  towns.  The  charcoal 
contains  no  soluble  matter,  but  by  grating  over  the  mucous  mem- 
brane of  the  stomach  and  intestines,  it  stimulates  the  organs  con- 
cerned in  digestion,  to  greater  activity,  and  enables  a larger  quantity 
of  chyle  to  be  separated  from  the  food  taken  along  with  it  than 
could  be  accomplished  without  its  agency. 

Such  is  the  fact,  likewise,  with  regard  to  salt — the  condiment  of 
condiments^  as  it  has  been,  not  improperly,  termed.  Where  children 
are  not  allowed  a proper  quantity  with  their  meals,  they  have  been 
observed  to  be  extremely  liable  to  the  generation  of  these  parasites  ; 
and  therefore  a due  allowance  is  always  to  be  permitted,  and  recom- 
mended. The  agriculturist  administers  it  liberally  for  the  prevention 
of  invermination  in  his  cattle  ; and  it  is  occasionally  given  to  both 
animals  and  man  as  a true  anthelmintic.  Fortunately,  it  is  much 
liked  by  children,  who  have  apparently  a natural  taste  for  it,  as  is 
the  case  with  the  individuals  of  the  animal  kingdom,  — the  buffalo  of 
our  own  country  daily  frequenting  the  salt  licks  of  the  west  to  enjoy 
the  treat ; and  all  our  domestic  cattle  lick  it  with  the  greatest  delight. 

In  the  twenty-ninth  volume  of  the  London  Medical  and  Physical 
Journal,  Mr.  Marshall  has  published  the  case  of  a lady  who  had  a 
natural  antipathy  to  salt  — which  is  rare  — and  who  was  dreadfully 
infested  with  worms  during  the  whole  of  her  life.  In  Ireland,  ac- 
cording to  Dr.  Paris,  where,  from  the  bad  quality  of  the  food,  the 
lower  classes  are  very  subject  to  worms,  a draught  of  salt  and  water 
is  a popular  and  efficacious  anthelmintic,  and  Lord  Somerville,  in 
his  address  to  the  English  Board  of  Agriculture,  refers  to  the  effects 
of  a punishment  which  formerly  existed  in  Holland.  ‘‘  The  ancient 
laws  of  the  country,”  says  h.is  lordship,  ordained  men  to  be  kept 


208 


SPECIAL  ANTHELMINTICS. 


on  bread  alone,  unmixed  with  salt,  as  the  severest  punishment  that 
could  be  inflicted  upon  them  in  their  moist  climate.  The  effect  was 
horrible  ; these  wretched  criminals  are  said  to  have  been  devoured 
by  worms  engendered  in  their  own  stomachs.” 

Where  the  practitioner  is  desirous  to  destroy  worms,  the  manage- 
ment may  have  to  be  somewhat  modified  by  the  particular  variety  ; 
but,  as  the  symptoms,  which  distinguish  these  from  each  other,  are 
by  no  means  unequivocal,  the  treatment  must  be  obscure  also.  This 
is,  however,  of  the  less  consequence,  as  all  entozoa  are  induced  by 
the  same  causes,  and  more  or  less  affected  by  the  same  vermifuges. 
As  the  ascarides  or  oxyures  vermiculares  occupy  the  lower  part  of 
the  bowels,  and  occasion  a troublesome  itching  within  the  rectum, 
their  presence  may  be  suspected,  and  medicines  can  be  introduced 
to  act  upon  them  immediately,  by  the  way  of  injection  ; aided,  or 
not,  by  anthelmintics,  administered  by  the  mouth.  In  all  cases,  per- 
haps, it  would  be  better  that  they  should  be  placed,  in  this  way,  be- 
tween two  fires,  as  it  were,  as  they  have  been  found  even  in  the 
upper  part  of  the  alimentary  tube,  whence  they  have  been  ejected 
by  vomiting  ; and  it  is  not  by  any  means  improbable,  that  the  an- 
noyance occasioned  by  a clyster  might  induce  them  to  migrate,  for 
the  purpose  of  seeking  quiet  in  the  higher  portions  of  the  intestines, 
or  at  least  of  getting  rid  of  the  irritation  to  which  they  may  have 
been  exposed  in  the  lower  portion.  In  all  cases  it  will  be  necessary 
to  investigate  the  condition  of  the  system,  that  favours  the  unusual 
generation  of  worms,  and  to  treat  it  accordingly  ; but  the  considera- 
tion of  this  subject  belongs  more  particularly  to  Special  Therapeutics. 


SPECIAL  ANTHELMINTICS. 

1.  True  Anthelmintics. 

O'LEUM  TEREBIN'THINiE  — OIL  OF  TUR'PENTINE. 

Oil  of  turpentine — whose  general  properties  are  described  else- 
where — singly,  or  combined  with  other  agents,  is  the  most  powerful 
of  the  direct  anthelmintics,  destroying  worms  rapidly  which  may  be 
immersed  in  it  out  of  the  body.  It  is  likewise  — as  elsewhere  shown 
— a cathartic,  so  that  it  is  rarely  necessary  to  administer  any  other 
cathartic  afterwards,  as  is  the  case  with  many  of  the  anthelmintics. 
Should  it  not  act  on  the  bowels,  however,  it  may  be  advisable  either 
to  associate  with  it  castor  oil,  or  to  follow  it  up  in  the  course  of  a 
few-  hours  by  a dose  of  this  oil,  inasmuch  as  when  it  does  not  pass 
off,  it  may,  according  to  Dr.  Copland,  by  being  absorbed,  give  rise 
to  encephalic  mischief,  and  occasionally  to  nephritic  symptoms.  It 


CHENOPODIUM. 


209 


is  applicable  to  every  variety  of  intestinal  worms,  and  has  proved 
very  efficacious  in  cases  of  taenia. 

It  may  be  given  in  the  dose  of  f.  to  f.  ^ss  and  more,  in  mo- 
lasses ; or  made  into  an  emulsion  with  the  yolk  of  egg  or  mucilage 
— (0/.  terebinth,  f.  _^ss  ; vitell.  ovi,  senmucilag.  acac.  f.  ^vj  ; Aquce 
menthce  piperit.  f.  gss  — M.)  Dr.  Pereira  states,  that  he  has  fre- 
quently administered  f.  5iss,  and  sometimes  f.  ^ij,  and  in  no  instance 
has  he  seen  any  ill  effects  from  it. 

In  cases  of  the  oxyures  or  ascarides  vermiculares,  oil  of  turpentine 
may  be  made  to  come  in  contact  with  them  in  the  form  of  enema. 

2.  O'LEUM  ANIMA'LE.  — ANIMAL  OIL. 

Animal  oil,  or  Bippel's  oil — Oleum  animaHe  Bippel'ii  — is  ob- 
tained by  subjecting  animal  substances  — as  bone  — to  destructive 
distillation.  The  commercial  article  is  derived  from  the  manufacture 
of  bone  black,  and  is  identical  with  the  Oleum  cornu  cervi  or  Oil  of 
hartshorn  of  the  older  Pharmacopoeias.  It  is  thick,  brown,  viscid, 
and  has  a most  disgusting  odour. 

The  oil  has  been  highly  extolled  as  an  anthelmintic  — by  the 
Germans  more  especially,  and  it  is,  unquestionably,  very  effective 
even  in  cases  of  taenia ; but  it  is  so  inexpressibly  nauseous,  that 
but  few  stomachs  can  retain  it.  Its  virtues  have  been  ascribed  to 
the  creasote  which  it  contains,  and  they  are,  doubtless,  dependent 
in  part  upon  that  constituent.  The  dose  is  rt\^v.  to  n\^xx.  in  mo- 
lasses, given  for  three  mornings  in  succession,  and  followed  by  a 
cathartic. 

The  Empyreumat'ic  Oil  of  Chabert,  made — as  before  remark- 
ed— by  adding  one  part  of  animal  oil  to  three  parts  of  oil  of  tur- 
pentine, leaving  them  to  combine  for  four  days,  and  then  distilling 
three  parts,  has  been  greatly  extolled.  It,  also,  is  very  nauseous. 
It  combines  the  anthelmintic  virtues  of  its  constituents,  and  may 
be  given  in  the  dose  of  a tea-spoonful  three  times  a day.  It  is  a very 
effective  vermifuge. 

3.  CHENOPO'DIUM.— WORMSEED. 

The  wormseed  of  the  United  States  is  the  fruit  of  Chenopo' dium 
Anthelmin'ticumo];  Jeru' Salem  Oak:  Sex.  Syst.  Pentandria  Digynia: 
Nat.  Ord.  Chenopodiaceae,  — the  wormseed  of  Europe  being  the  fruit 
of  Artemis'ia  Santon'ica,  (Dublin  College,)  or  of  a variety  of  A. 
Marit'ima.  Dr.  Pereira,  however,  affirms,  that  the  substance  sold 
in  Great  Britain  under  the  name  of ‘‘  wormseed,”  does  not  consist 
of  seeds,  but  of  broken  peduncles,  mixed  with  the  calyx  and  flower- 
buds. 

Chenopodium  anthelminticum  is  an  indigenous  plant,  which  grows 
in  almost  every  part  of  the  United  States,  but  especially  to  the  south, — 
being  found  in  the  vicinity  of  rubbish,  along  fences  ; flowering  from 
July  to  September,  the  seeds  ripening  in  autumn.  These  are  small, 
roundish,  light,  of  a very  bitter  peculiar  taste,  and  of  a disagreeable 
18^ 


210 


SPECIAL  ANTHELMINTICS. 


odour,  which  is  possessed  by  the  whole  plant.  Their  properties  are 
dependent  upon  a volatile  oil  separable  by  distillation  with  water. 

Fig.  25.  Chenopo'diumambrosiotdeSy 

an  indigenous  plant,  is  said  to 
be  used  indiscriminately  for  it. 

The  seed  of  the  chenopo- 
dium  is  one  of  the  most  po- 
pular anthelmintics  in  use  in 
the  United  States  ; and  the 
common  mode  of  prescribing 
it  to  a child  three  or  four 
years  old  is  to  mix  one  or 
two  scruples  of  the  powder 
with  molasses  ; administering 
this  for  three  nights  in  suc- 
cession, and  then  prescribing 
a cathartic  on  the  following 
morning. 

O'LEtJM  CHENOPO'DII  or  oil  of 
wormseedj  Wormseed oil,  is  offi- 
cinal in  the  Pharmacopoeia  of 
the  United  States.  It  is  of  a 
bright  yellow  colour  when 
freshly  distilled,  but  becomes 
darker  by  age.  It  is  admi- 
nistered in  the  same  manner 
as  the  powder,  in  the  dose  of 
four  to  eight  drops.  It  may 
be  mixed  with  sugar  or  mo- 
Chenopodium  Amhelminticum,  laSSeS. 


4.  SPIGE'LIA.  — PINKROOT. 


Spigelia  is  the  root  of  Spigdlia  Mariland'ica,  Indian  Pink^  Ca- 
roli'na  Pink  OY  Per en'7iial  Wormgrass,  Sex.  Syst.  Pentandria  Mono- 
gynia;NAT.  Oud.  Gentianaceae;  — Spigeliacese  (Martins),  an  indige- 
nous plant  of  the  States  south  of  the  Potomac,  which  grows  in  rich 
soils  on  the  edges  of  woods,  and  flowers  from  May  to  July.  It  is 
collected  in  quantities  by  the  Creeks  and  Cherokees,  by  whom  it 
is  packed  in  casks,  or,  more  frequently,  in  large  bales,  weighing 
from  300  to  350  lbs.  ; — that  in  the  casks  being  preferred  as  less 
likely  to  be  damp  and  mouldy.  (Wood  & Bache.) 

The  dried  root,  as  met  with  in  the  shops,  consists  of  numerous, 
slender , branching,  crooked  and  wrinkled  fibres,  issuing  from  a short 
rhizoma.  'Ehese  fibres  are  from  three  to  six  inches  long.  Its  odour 
is  faint  ; and  taste  sweetish  and  slightly  bitter.  Its  activity  has 
been  assigned  by  Feneulle  to  a brown  bitter  extractive,  similar  to 


SPIGELIA. 


211 


that  of  the  cathartic  Leguminosae,  which,  when  taken  internally, 
causes  vertigo  and  a kind  of  Fig.  26. 

intoxication.  The  virtues  of 
spigelia  are  imparted  to  boil- 
ing water. 

The  roots  are  sometimes 
mixed  with  those  of  a small 
creeping  plant,  w*hich  twines 
round  the  stem.  These  are 
much  smaller  and  lighter  co- 
loured, and  should  be  sepa- 
rated before  the  spigelia  is 
dried. 

Pinkroot  is  much  used  in 
the  United  States  as  an  an- 
thelmintic, and  although  cases 
are  related  in  which  it  is  said 
to  have  proved  acro-narcotic, 
and  even  to  have  caused 
death,  it  is  very  extensively 
prescribed,  and  with  entire 
impunity.  Stdl,  it  is  well  to 
bear  in  mind,  that  such  cases 
have  been  recorded,  as  well 
as  the  statement,  that  the 
acro-narcotic  effects  are  less 
apt  to  occur  when  the  medi- 
cine acts  on  the  bowels,  or 
is  combined  with  cathartics. 

Dr.  Wood  affirms,  that  in  the 
United  States,  it  stands  at  the 
head  of  the  anthelmintics.  It 
certainly  is  highly  esteemed 
by  many,  but  others  have 
equal  confidence  in  the  che- 
nopodium,  and  much  more  in 

the  oil  of  turpentine  and  its  Spigelia  Marilandica. 

combinations.  It  is  scarcely  used  in  Great  Britain,  although  it  is  offi- 
cinal in  the  Pharmacopoeias  of  London,  Edinburgh,  and  Dublin. 

The  dose  of  the  powdered  root,  for  a child  a few  years  old,  is 
from  ten  to  twenty  grains,  and  for  an  adult  from  one  to  two  drachms. 
This  may  be  given  every  night,  or  every  night  and  morning,  for  three 
successive  days,  and  then  be  followed  by  a brisk  cathartic.  Or  it  may 
be  associated  with  calomel,  jalap,  or  any  of  the  cathartic  powders. 

immi  SPIGE'Ll INFU'SION  OF  PINK-ROOT.  {Spigel.  §ss  ; Mqucs  huU 
lient.  Oj.)  The  dose  of  this  infusion,  for  a child  a few  years  old,  is 
f.  5ss.  to  f.  ^i ; for  an  adult,  f.  §iv.  to  f.  Jviii,  given  in  the  same 
manner  as  directed  for  the  powdered  root,  or  an  equal  quantity  of 


212 


SPECIAL  ANTHELMINTICS. 


senna  may  be  added  to  the  infusion.  A preparation  is  generally 
kept  in  the  shops,  which  is  said  to  be  much  prescribed  by  physicians 
under  the  name  of  worm-tea^  and  which  consists  of  pink-root,  senna, 
manna  and  savine,  mixed  together  in  various  proportions  to  suit  the 
views  of  the  prescriber.  (Wood  & Bache.)  The  author  has  never 
used  it,  nor  seen  it  used. 

5.  FILIX  MAS.— MALE  FERN. 

Filix  Mas,  of  the  secondary  list  of  the  Pharmacopoeia  of  the  United 
States,  is  the  rhizoma  of  Aspid'ium  Filix  Mas  or  JYephro' dium  Filix 
Mas;  Sex.  Syst.  Cryptogamia  Filices ; Nat.  Ord.  Filices ; a 
plant  which  is  indigenous  in  this  country  in  shady  pine  forests,  from 
New  Jersey  to  Virginia,  as  well  as  in  those  of  Europe,  Asia,  and 
Africa.  The  rhizoma  should  be  collected  in  the  months  of  July, 
August,  or  September.  The  sound  parts  are  to  be  carefully  dried 
and  reduced  to  powder.  When  dried,  its  odour  is  weak,  taste 
sweet,  and  mucilaginous,  slightly  bitter  and  austere.  It  is  generally 
brought  to  this  country  from  Europe. 

Fig.  27. 


Nephrodium  Filix  mas. 

A.  Pinnule  with  nine  sori.  (a.) 

B.  Magnified  portion  of  i>innule  with  the  sporangia. 

a.  Stomata.  b,b,  Sporangia  partially  covered  by  e.  the  indusium. 

C.  Magnified  sporangium. 

a.  Stalk,  b.  Ring.  c.  Membranous  sac. 

D.  Ruptured  Sporangium  with  the  sporule  escaping. — (Pereira.) 

As  met  with  in  the  shops,  it  consists  of  fragments  of  the  dried 
thickened  bases  of  the  footstalks,  to  which  small  portions  of  the  rhi- 
zoma are  found  adhering,  and  of  the  root  fibres.  It  is  recommended, 
that  the  stock  of  the  apothecary  should  be  renewed  annually,  as  in 
two  years  the  best  article  becomes  useless. 

Filix  mas  has  been  analysed  by  various  individuals,  and  it  is  pro- 
bable,that  the  anthelmintic  virtues  reside  in  volatile  oil,  which  exists 
in  it  to  the  amount  of  about  7 per  cent.  It  contains,  likewise,  tannic 
and  gallic  acids,  which  communicate  to  it  its  astringent  properties. 

The  root  of  the  male  fern  has  only  been  used  as  an  anthelmintic. 
It  was  the  basis  of  Madame  Nouffer’s  celebrated  remedy  for  taenia, 
which  was  purchased  by  Louis  XVI.,  in  1775,  for  18,000  francs. 

The  dose  of  the  powdered  root  is  one  to  three  drachms,  given  in 
molasses  for  three  nights  in  succession,  and  followed  by  a brisk  ca- 
thartic in  the  morning.  The  plan  adopted  — and  successfully,  in 


GRANATI  RADICIS  CORTEX. 


213 


many  cases, — by  Madame  NoufFer,  was  to  give  two  or  three  drachms 
of  the  powder  in  from  four  to  six  ounces  of  water,  in  the  morning 
fasting,  and  two  hours  afterwards,  a purgative  bolus  composed  of  ten 
grains  of  calomel^  ten  of  scammony^  and  six  or  seven  of  gamboge. 
But  the  most  effectual  preparation  would  seem  to  be  that  proposed 
by  M.  Peschier  of  Geneva  — the  ethereal  extract,  which  has  been 
called  also  O'leum  Fi'licis,  and  Extrac'tum  Fi'licis  ^the'reum, 
which  contains  not  only  the  volatile  oil,  but  also  a fixed  oil,  tannic, 
gallic,  and  acetic  acids,  a muco-saccharine  matter,  green  and  red 
colouring  matter,  and  a semi-resinous  substance.  It  is  made  by 
digesting,  in  the  cold,  the  root,  cut  small,  for  ten  or  twelve  days,  in 
a sufficient  quantity  of  sulphuric  ether  ; after  which  the  strained  liquor 
is  evaporated  until  the  ether  is  removed.  Peschier  had  known  it 
to  be  successful  in  150  cases,  when  he  wrote;  Ullersberger  had 
used  it  in  60  cases,  and  a medical  friend  of  his  in  200  cases,  with 
invariable  success.  It  is  affirmed  to  have  been  found  more  success- 
ful against  the  Bothriocephalus  latus  than  the  Tcenia  solium;  and  a 
part  of  the  discrepancy  of  results  has  been  ascribed  to  this  cause. 
For  example,  it  has  not  been  found  as  effectual  in  the  treatment  of 
taenia  at  Paris,  and  the  entozoon  most  common  is  the  Taenia  Solium. 

The  dose  of  the  ethereal  extract  is  from  twelve  to  twenty-four 
grains.  It  may  be  given  in  the  form  of  pill  or  in  molasses,  for  two 
or  three  nights  in  succession,  and  then  be  followed  by  a brisk  ca- 
thartic. 

The  Ethereal  Tincture  of  the  Buds  of  the  Male  Fern  (one  part 
of  the  buds  to  eight  of  ether)  has  been  used  with  advantage  as  an 
anthelmintic  ; and  a decoction  in  the  proportion  of  an  ounce  of  the 
rhizoma  to  a pint  of  water  has  been  occasionally  prescribed. 

6.  GRANA'TI  RADI'CIS  CORTEX.  — BARK  OF  POMEGRAN'ATE  ROOT. 

Pu'nica  Grana'tum  or  Pomegran'ate ; Sex.  Syst.  Icosandria  Mo- 
nogynia;  Nat.  Ord.  Myrtacese;  — Granateae 
(Don,)  appears  to  be  a native  of  northern 
Africa,  whence  it  was  transported  to  Italy 
at  the  time  of  the  Carthaginian  wars.  It  is 
also  indigenous  in  Bengal,  China,  and  Persia. 

The  bark  of  the  root  — which  is  the  part 
used  as  an  anthelmintic — is  usually  in  small 
fragments,  in  quills  or  portions  of  quills,  of 
a yellowish,  or  ash-grey  colour  externally  ; 
and  yellow  within.  It  is  brittle  and  not 
stringy,  and  has  a faint  peculiar  smell,  and 
an  astringent  taste.  It  has  often  been  sub- 
jected to  analysis  ; and  has  been  found, 
by  M.  Latour  de  Trie,  to  contain,  1,  a mat- 
ter, which  was  considered  to  be  peculiar, 
and  to  which  the  name  of  Gran'adin  or 
Gren’adin  was  given,  but  which  has  been 


Fig.  28. 


Punica  granatum. 


shown  to  be  mannite. 


214 


SPECIAL  ANTHELMINTICS. 


2.  Tannic  acid,  to  which  — as  well  as  to  a small  portion  of  gallic 
acid  — its  astringency  is  owing  ; and  3.  Resin.  The  analysis  sheds 
no  light  on  its  anthelmintic  properties.  It  yields  its  virtues  freely  to 
water. 

Pomegranate  root  bark  is  rarely  employed  at  the  present  day  ex- 
cept as  an  anthelmintic,  and  not  often  with  that  view.  It  is  said, 
when  given  in  full  doses,  to  induce  nausea,  vomiting  and  purging, 
and  occasionally  giddiness  and  faintness,  which  would  seem  to  show 
that  it  possesses  acro-narcotic  properties,  on  which  its  anthelmintic 
virtues  may  be  dependent. 

The  testimony  in  favour  of  the  bark  as  an  anthelmintic  has  been 
discordant.  It  is  especially  in  cases  of  taenia  that  it  has  been  em- 
ployed ; and  numerous  trials  have  been  made  with  it  in  England, 
France,  Germany,  and  Italy  ; yet  in  extensive  experiments  at  the 
Polyclinical  Institute  of  Berlin  it  proved  of  no  value ; but  this  failure 
was  referred  to  some  imperfection  in  the  drug. 

The  fresh  bark  possesses  far  more  virtue  than  the  dried  : the  latter 
has,  indeed,  been  regarded  as  inert.  It  is  almost  always  given  in 
decoction,  which  may  be  prepared  with  two  ounces  of  the  hark^ 
boiled  in  a quart  of  water  down  to  a pint  and  a half.  Of  this,  the 
dose  is  f.  §ij,  every  half  hour  until  the  whole  is  taken.  The  formula, 
cited  by  Paris  from  Ainslie’s  Materia  Medica  of  Hindusthanf  di- 
rects it  to  be  prepared  with  ^ij  of  the  fresh  hark^  boiled  in  a pint 
and  a half  of  water ^ until  only  three  quarters  of  a pint  remain. 

An  alcoholic  extract  of  the  hark  of  the  root  is  recommended  by 
Deslandes. 


7.  AZED'ARACH.  — AZED'ARACH. 

The  bark  of  the  root  of  Me'lia  Azed' arach  ; Sex.  Syst.  Decandria 
Monogynia  ; Nat.  Ord.  Meliacese  ; is  in  the  secondary  list  of  the 
Pharmacopoeia  of  the  United  States.  The  tree,  termed  Pride  of  China, 
Pride  of  India,  Bead  Tree,  and  Poisonberry  Tree,  is  a native  of 
oriental  countries  ; but  is  cultivated  as  an  ornament  in  various  parts 
of  the  world.  It  is  very  common  in  the  Southern  states,  but  does 
not  flourish  farther  north  than  Virginia. 

The  berries  are  reputed  to  be  poisonous,  yet  they  are  said  to  be 
eaten  by  children  at  the  south  without  inconvenience,  and  are  con- 
sidered to  be  anthelmintic.  The  bark  of  the  root  — the  officinal 
portion  — has  a bitter  nauseous  taste.  Its  virtues  are  imparted  to 
boiling  water.  It  is  regarded  by  many  as  one  of  the  most  valuable 
anthelmintics  ; and  when  given  in  large  doses  is  unquestionably 
acro-narcotic.  It  is  usually  prescribed  in  decoction.  (Azedarach. 
recent,  ^iv  ; Aquce,  Oij  : cocque  ad  Oj,  et  cola.  Dose,  f.  5ss.  every 
two  or  three  hours,  till  it  exhibits  its  effects  on  the  stomach  or 
bowels.)  1 


TANACETUM. 


215 


8.  FUCUS  HELMINTHOCOR'TON. 

Facus  Helminthocor' ton ^ Helminthocor'ton  or  Cor'sican  Wormweed; 
Nat.  Ord.  Algae;  — Algaceae  (Lindley),  is  a marine  plant,  which 
grows  on  the  coast  of  the  Mediterranean,  and  especially  of  the  Island 
of  Corsica. 

The  whole  plant  is  employed  as  an  anthelmintic  in  Europe  ; but 
it  is  not  used  in  this  country.  The  American  editors  of  the  Manual 
of  Materia  Medica  and  Pharmacy^  by  Edwards  and  Vavasseur,  affirm 
that  it  is  the  best  vermifuge  with  which  they  are  acquainted,  and  that 
they  witnessed  in  Corsica  the  most  astonishing  effects  from  it. 

The  dose  of  the  powder  is  from  gr.  x.  to  5ij.  mixed  with  molasses. 
It  is  also  given  in  infusion  and  decoction^  and  it  is  affirmed  by  Dr. 
James  Johnson,  that  when  thrown  into  the  rectum  it  ‘‘  destroys  any 
worms  domiciliating  there  as  effectually  as  choke-damp  would  destroy 
the  life  of  a miner.”  Yet  its  effects  on  the  economy  are  scarcely 
appreciable  ; and  chemical  anal}>sis  sheds  no  light  in  regard  to  its 
anthelmintic  principle  or  principles. 

9.  SO'DII  CHLORIDUM.  — CHLORIDE  OF  SO'DIUM. 

The  value  of  common  salt  — whose  general  properties  are  de- 
scribed under  Cathartics — as  a condiment  in  the  prevention  of 
worms,  has  already  been  mentioned,  (p.  207.)  It  was  also  re- 
marked, that  experiments  have  shown  it  to  be  detrimental  to  those 
entozoa  when  out  of  the  body.  Hence  it  has  been  administered 
as  a true  anthelmintic.  Its  cathartic  agency  might  entitle  it  to  be 
placed  also  under  another  of  the  divisions  of  anthelmintics. 

When  given  as  a true  anthelmintic,  it  is  generally  in  large  doses 
from  5SS.  to  i cases  of  oxyures  or  ascarides  vermiculares, 

it  may  be  thrown  into  the  rectum  in  strong  solution. 

10.  TANACE'TUM.  — TANSY. 

The  herb  Tana ce' turn  vulga're  or  Tansy : Sex.  Syst.  Syngenesia 
Polygamia  superflua ; Nat.  Ord.  Composite  Corymbiferae ; is  an 
herbaceous  plant,  indigenous  in  Europe,  but  introduced  into  this 
country,  where  it  grows  wild  on  the  road-sides,  and  is  cultivated  in 
the  gardens.  It  flowers  from  July  to  September. 

The  whole  herb  has  a strong,  peculiar  and  disagreeable  odour, 
and  a nauseous,  bitter,  and  aromatic  taste.  It  has  been  subjected 
to  analysis,  and  found  to  be  essentially  composed  of  volatile  oil  — 
O leum  Tanace'ti — which  has  the  peculiar  smell  of  the  plant,  and 
a warm  bitter  taste  ; and  of  a bitter  matter,  which  is  usually  de- 
nominated extractive,  ffiut  has  been  regarded  as  partly  resinous. 
Still,  the  main  properties  are  extracted  by  water,  and  all,  probably, 
by  alcohol. 

Tansy  is  chiefly  used  as  an  anthelmintic  in  domestic  practice.  It 
is  rarely  prescribed  by  the  physician,  and  is  therefore  placed  in  the 
secondary  list  of  the  Pharmacopoeia  of  the  United  States.  Its  an- 
thelmintic virtues  are  probably  dependent  both  on  the  bitter  princi- 


216 


SPECIAL  ANTHELMINTICS. 


pie  and  the  volatile  oil ; the  latter  of  which  is  more  destructive  to 
the  parasites,  whilst  the  former,  like  bitters  in  general,  is  adapted 
for  giving  tone  to  the  digestive  function  and  to  the  system  in  gene- 
ral ; yet  ihe  seeds,  which  contain  the  largest  proportion  of  the  bitter 
principle,  and  the  smallest  of  volatile  oil,  are  said  to  be  most  effec- 
tive. It  is  generally  given  in  infusion  — Tansy  Tea  ; prepared  by 
infusing  ^ij.  of  the  herb  in  Oj.  of  boiling  waler^  the  dose  being  from 
f.  to  f.  5iij. 

The  seeds  might  be  given  in  powder,  in  the  dose  of  from  gr.  xxx. 
to  5j  ; or  a few  drops  of  the  oil  might  be  administered  in  molasses. 

11.  CREASO'TON.  — CRE'ASOTE. 

{For  its  general  properties^  see  Excitants). 

Several  portions  of  tapeworm  having  been  observed  to  be  dis- 
charged during  the  administration  of  creasote,  it  was  prescribed,  in 
such  cases,  as  a true  anthelmintic.  From  five  to  eight  drops  may  be 
given  to  adults  in  an  ordinary  dose  of  oleum  ricini.  It  has  likewise 
been  associated  with  oleum  tiglii. 

II.  Mechanical  Anthelmintics. 

MUCU'NA.  — COWHAGE. 

Mucuna,  in  the  language'' of  the  Pharmacopoeia  of  the  United 
States,  is  the  ‘‘  bristles  of  the  pods  of  Mucu'na  pru'riens,  Dol'ichos 
pru'riens^  Stizolo'bium  pru'riens,  Cowhage  ov  Cowitch.’’^  Sex.  Syst. 
Diadelphia  Decandria  ; Nat.  Ord.  Leguminosae  — a climbing  plant, 
indigenous  in  the  West  Indies.  The  pod  or  legume  — as  met  with  in 
the  shops  — is  of  a brownish  colour,  shaped  like  the  italic  5,  contain- 
ing four  to  six  seeds,  and  covered  with  a pubes  of  stinging  hairs  — 
setce  — which,  when  placed  on  the  skin,  pierce  it,  and  give  rise  to 
intense  itching,  and,  in  some  persons,  to  cutaneous  inflammation. 
The  best  application,  in  such  cases,  is  oil.  Rubbing  the  part  always 
increases  the  local  phenomena. 

Mucuna  has  long  been  celebrated  as  a mechanical  anthelmintic. 
That  its  action  is  mechanical  is,  indeed,  proved  by  the  circum- 
stances, long  ago  observed,  that  worms,  under  its  use,  are  discharged 
alive.  When  experiments,  too,  have  been  made  on  entozoa  out  of 
the  body,  the  setae  have  been  observed  sticking  in  them,  and  the 
animals  twisting  about  evidently  in  great  torture.  That  an  anthel- 
mintic effect  is  produced  upon  them  by  cowhage  within  the  human 
body  appears  to  be  well  supported.  The  testimony  in  favour  thereof 
has  been  satisfactory,  and  the  author  himself  has  repeatedly  seen 
its  exhibition  followed  by  the  evacuation  of  entozoa  after  other  an- 
thelmintics had  been  given  fruitlessly. 

The  difficulty  has  been  to  understand  how  it  could  act  upon  the 


PULVIS  STANNI. 


217 


worms,  and  not  equally  irritate  the  lining  membrane  of  the  intes- 
tines ; hence  the  efficacy  of  the  medicine  has  been  discredited.  It 
is  impossible,  however,  to  set  aside  the  numerous  facts  that  have 
been  adduced  in  its  favour ; and  it  would  seem,  that  the  mucus, 
which  covers  the  membrane,  may  prevent  the  setae  from  penetrating 
it  as  it  does  the  worms. 

Mucuna  has  been  considered  best  adapted  for  the  removal  of 
Ascarides  lumhricoides  or  the  long  round  worm,  and  Oxyures  vermi- 
culares  or  the  small  thread  worm.  The  latter  are,  however,  so  low 
down  in  the  intestinal  canal,  that  its  influence  can  scarcely  be  so 
powerful  on  them. 

It  may  be  given  in  the  form  of  electuary,  the  pods  being  dipped 
in  molasses,  and  the  setae  scraped  off  until  the  mixture  has  attained' 
the  consistence  of  thick  honey.  Of  this,  a table-spoonful  is  a dose 
for  an  adult ; a tea-spoonful  for  a child  three  or  four  years  old. 
This  may  be  administered  for  three  nights  in  succession ; and  the 
following  morning,  a brisk  cathartic  may  be  given. 

It  is  not  much  used  in  this  country ; and  the  framers  of  the  last 
edition  of  the  Pharmacopoeia  of  the  United  States  have  transferred  it 
from  the  primary  to  the  secondary  list. 

13.  COR'YLUS  ROSTRA'TA.  — BEAKED  HAZEL. 

Beaked  Hazel  is  a shrub  two  or  three  feet  high,  of  the  Nat.  Ord. 
Amentaceae  ; Sub.  Ord.  Cupuliferse  ; Stx.  Syst.  Monoecia  Polyandria, 
which  grows  in  the  mountainous  regions  of  North  America.  The 
nut  which  it  produces  is  of  an  ovate  shape,  surrounded  by  a cori- 
aceous and  scaly  involucre  or  cupula,  terminating  in  a tube  an  inch 
and  a half  long,  covered  with  short  and  thick  bristles,  very  similar 
to  those  of  mucuna.  These  have  been  found  by  Dr.  Heubener,  of 
Bethlehem,  Pennsylvania,  to  possess  similar  anthelmintic  virtues 
with  mucuna,  and  to  be  equal  to  it  in  all  respects. 

It  may  be  given,  like  mucuna,  in  syrup,  molasses  or  other  con- 
sistent vehicle,  and  in  the  same  doses. 

14.  PULVIS  STANNI.  — POWDER  OF  TIN. 

Powder  of  Tin,  Gran'ulated  or  Gran^ular  Tin^  is  prepared  by 
melting  tin  in  an  iron  vessel  over  the  fire,  and,  whilst  it  is  cooling, 
stirring  it  until  it  is  reduced  to  a powder,  after  which  it  is  passed 
through  a sieve.  Tin  may  also  be  reduced  to  powder  by  shaking  it, 
when  melted,  in  a wooden  box,  the  inside  of  which  has  been  rubbed 
with  chalk. 

The  testimonials  in  favour  of  this  mechanical  anthelmintic  have 
been  numerous.  It  has  been  strongly  recommended  not  only  in 
Ascarides  lumhricoides^  but  also  in  Tcenia  solium.  It  was  at  one 
time  conceived,  that  its  good  effects  might  be  owing  to  its  combi- 
nation with  arsenic,  but  this  supposition  has  been  negatived  by  the 
equal  success  following  its  use  in  a pure  state.  In  all  probability,  it 
acts  by  the  incessant  annoyance  occasioned  by  the  friction  of  the 
VOL.  I. — 19 


218 


EXPECTORANTS. 


particles  of  the  tin,  which  renders  the  situation  of  the  entozoa  un- 
comfortable to  them,  and  induces  them  to  migrate ; whilst  the  same 
friction  on  the  mucous  coat  of  the  intestines  increases  their  peristaltic 
action,  and  favours  the  object ; or,  if  it  fail  to  do  this,  it  augments 
chylosis,  and  improves  the  general  tone  of  the  digestive  system. 

The  dose  to  children  is  from  ^^ss.  to  5ij-  and  more ; to  adults  ^ss. 
and  more,  in  molasses,  every  night,  for  three  nights.  On  the  follow- 
ing morning  a brisk  cathartic  may  be  given. 


SECTION  II. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  RESPIRATORY  ORGANS. 

EXPECTORANTS. 

Synon.  Anacathartics. 

Definition  of  expectorants  — Organs  on  which  they  act  — Modus  operandi  — Are  indi- 
rect agents  only  — Inhalations — Special  Expectorants. 

Expectorants  are  usually  defined  to  be  — “ Agents  that  promote 
the  excretion  of  mucus  and  other  fluids  from  the  lungs  and  air 
passages.” 

To  understand  whether  we  be  possessed  of  any  substances  that 
exert  a special  action  of  this  kind,  it  is  necessary  to  inquire  into  the 
anatomical  constitution  of  the  bronchial  tubes,  and  into  the  mode  in 
which  reputed  expectorants  may  affect  them. 

The  whole  of  the  larynx,  the  trachea,  and  probably  the  bronchial 
tubes,  are  lined  by  a mucous  membrane,  whose  office  it  is  to  secrete 
mucus,  and  to  serve  the  purpose  of  the  mucous  membranes  in  general. 
From  this  membrane  it  is,  that  the  humour  of  expectoration  is  secreted. 
Surrounding  the  air  tubes,  probably  even  in  their  minutest  divisions, 
is  a contractile  coat,  which  has  an  important  agency  in  the  phenomena 
of  expectoration.  In  the  trachea,  an  obvious  muscular  structure 
exists  in  its  posterior  third,  where  the  cartilages  are  wanting.  It 
consists  of  a thin,  muscular  plane,  the  fibres  of  which  pass  transversely 
between  the  interrupted  extremities  of  the  cartilaginous  rings  of  the 
trachea  and  the  bronchia.  The  use  of  this  muscular  tissue,  as  sug- 
gested by  Dr.  Physick,  and,  since  him,  by  Cruveilhier,  Sir  Charles 
Bell,  and  others,  is  to  diminish  the  calibre  of  the  air  tubes  in  ex- 
pectoration ; so  that  the  air,  having  to  pass  through  the  contracted 
portion  with  greater  velocity,  its  momentum,  in  coughing,  may  re- 
move the  secretions,  that  are  adherent  to  the  mucous  membrane. 
The  phenomena  of  asthma,  as  Laennec  has  correctly  observed, 
occasionally  exhibit  a manifest  temporary  constriction  of  the  minute 
bronchial  ramifications,  affording,  indeed,  every  evidence  of  a spas- 
modic attack,  — the  essential  cause  being  probably  seated  in  the 
ramifications  of  the  pneumogastric  nerves  distributed  to  the  bronchial 
tubes,  whilst,  at  other  times,  the  phenomena  indicate  rather  a para- 
lysed than  a spasmodic  condition  of  the  muscular  fibres. 


MODUS  OPERANDI. 


219 


The  quantity,  and  facility  with  which  the  matter  of  expectoration 
is  secreted,  must  depend  upon  the  condition  of  the  mucous  mem- 
brane. Occasionally,  indeed,  the  sputum  is  derived  from  the 
breaking  down  of  tubercles,  or  from  positive  abscesses  in  the  lungs, 
but  these  are  not  the  most  common  cases  in  which  expectorants  are 
employed  ; — such,  at  least,  as  are  regarded  to  exert  a specific 
agency  on  the  lining  membrane  of  the  air-passages,  when  taken  into 
the  stomach,  or  introduced,  in  any  manner,  into  the  circulation.  If 
the  bronchial  mucous  membrane  be  inflamed,  as  in  acute  bronchitis, 
the  secretion  from  it  may  be  wholly  arrested  for  a time,  after  which 
it  may  become  augmented,  as  in  cases  of  inflammation  of  the  mu- 
cous membranes  in  general  ; or,  if  the  inflammation  be  to  a less  ex- 
tent, and  protracted,  a profuse  secretion  may  take  place  from  it,  at- 
tended with  every  symptom  of  general  asthenia,  as  in  some  of  the 
cases  of  winter-cough  or  chronic  bronchitis  of  old  people.  In  these 
different  conditions  of  the  mucous  membrane,  a different  condition 
of  expectorant  medication  must  be  demanded.  In  the  former,  marked 
by  every  sign  of  internal  inflammation,  the  antiphlogistic  plan  is  im- 
periously required  ; whilst  in  the  latter,  depletion  is  by  no  means  in- 
dicated: on  the  other  hand,  general  and  local  excitants  maybe 
found  advisable.  These,  however,  are  indirect  expectorants  — 
adapted  for  the  removal  of  the  condition  of  the  system,  which  gives 
rise  to  the  diminished  or  augmented  secretion  from  the  bronchial  mu- 
cous membrane. 

Again,  when  the  sputa  are  secreted,  they  often  adhere  to  the  mem- 
brane, and  are  expelled  with  difficulty ; at  times,  because  the  inflam- 
matory condition,  above  mentioned,  does  not  admit  of  their  ready  de- 
tachment ; and,  at  others,  owing  to  a want  of  due  vigour  in  the 
system  in  general,  and  in  the  muscles,  concerned  in  expectoration, 
in  particular.  In  the  former  case,  antiphlogistics,  nauseants,  &c. 
become  indirect  expectorants  ; in  the  latter,  substances,  which,  like 
ammoniacum,  myrrh,  and  the  different  balsams,  are  excitants ; or, 
again,  agents,  that  are  capable  of  inducing  emesis,  during  the  suc- 
cussion  accompying  whose  operation,  the  mucous  becomes  detached, 
and  its  expulsion  favoured.  In  these  cases,  a nauseating  emetic  is 
most  beneficial,  if  inflammatory  irritation  exists  to  any  extent  ; for, 
during  the  nausea,  which  precedes  emesis,  the  secretion  from  the 
bronchial  mucous  membrane  is  favoured,  and  by  the  act  of  vomiting 
succeeding  to  the  secretion  the  mucus  is  readily  detached,  and  ex- 
pectorated. In  this  Avay,  consequently,  nauseants  and  emetics  be- 
come expectorants. 

All  these,  however,  are  indirect  agencies  only,  and  it  is  important 
to  inquire,  whether  there  be  such  remedies  as  direct  expectorants ^ or, 
in  other  words,  any  that  act  on  the  bronchial  mucous  membrane  spe- 
cifically, or  by  preference,  after  having  been  received  into  the  sto- 
mach, and  entered  the  mass  of  blood  ; for,  it  is  manifest,  that  this 
is  the  only  mode  in  which  any  internal  expectorant  can  come  into 
immediate  contact  with  the  seat  of  the  mischief.  The  expectorant 


220 


EXPECTORANTS. 


whatever  it  may  be,  must  be  received  into  the  circulation,  either  by 
imbibition  through  the  coats  of  the  gastro-enteric  blood-vessels, 
or  through  the  chyliferous  vessels.  In  either  case,  it  must  proceed 
to  the  heart,  and  pass  with  the  blood  of  the  bronchial  artery  to 
the  bronchial  mucous  membrane ; and  although  it  cannot  be  de- 
nied, that  many  local  excitants,  when  received  into  the  blood- 
vessels, affect  the  particular  parts  of  the  frame  on  which  they  act 
by  preference,  we  have  no  sufficient  reason  for  the  belief,  that  this 
is  the  case  with  any  of  the  remedies,  that  are  reputed  to  be  expec- 
torants. None  of  them  appear  to  affect  the  bronchial  mucous  mem- 
brane by  preference  : they  exert  upon  it  an  indirect  agency  only. 
An  attentive  examination  of  the  properties  ascribed  to  the  different 
agents,  ranked  under  this  division,  can  scarcely  fail,  indeed,  to  lead 
the  intelligent  therapeutist  to  the  deductions  of  Dr.  Paris.  If  the 
term  expectorant he  remarks,  be  intended  to  express  a medicinal 
substance,  which  has  the  power  of  promoting  the  expulsion  of  fluid 
from  the  lungs,  by  some  specific  action  on  the  parts  concerned,  we 
can  have  no  hesitation  in  at  once  rejecting  the  word,  and  denying 
the  existence  of  such  remedies;  if,  however,  the  term  be  received 
conventionally,  as  comprehending  all  those  substances,  which  are 
capable,  according  to  the  state  of  the  system  in  each  particular  case, 
of  producing  expectoration,  it  will  be  extremely  proper  to  recognise, 
and  particularly  useful  to  retain,  such  a class  of  medicinal  agents.” 
A still  more  recent  writer.  Dr.  Spillan,  has  remarked,  that  there  pro- 
bably exists  no  class  of  medicines,  which  so  fully  establish  the  truth 
of  the  principle,  that  medicines  are  but  relative  agents,  as  the  class 
now  under  consideration.” 

These  are  the  only  views,  that  can  be  rationally  maintained,  and 
much  careful  discrimination,  accordingly,  becomes  necessary  to  de- 
termine upon  the  precise  kind  of  indirect  agency  that  may  be  de- 
manded in  any  particular  case  : immense  mischief  has,  indeed,  been 
done  by  the  promiscuous  prescription  of  reputed  expectorants,  under 
circumstances  contra-indicating  their  employment.  The  pathology 
of  many  of  the  varieties  of  cough  has  been  but  little  attended  to, 
until  of  late  years.  Its  frequent  identity  with  bronchitis  was  not  sus- 
pected, or  if  suspected,  disregarded.  Expectorants,  in  such  cases, 
were  freely  administered,  — that  is,  substances  considered  to  be  pos- 
sessed of  direct  powers  over  the  parts  concerned  in  the  formation  of  the 
matter  of  expectoration ; and  as  almosfall  these  remedies  belonged  to 
the  class  of  excitants,  it  may  be  imagined,  that  ^mischief  frequently 
followed  their  administration.  This  every]  practitioner)  must  have 
witnessed  from  the  injudicious  use  of  excitant  cough  mixtures,  often 
administered  when  the  system  has  been  labouring  under  general 
febrile  indisposition,  connected  with,  or  dependent  upon,  the  bron- 
chitis, for  which  the  expectorant  was  originally  recommended.  The 
judicious  practitioner,  in  such  cases,  whilst  he  pays  proper  attention 
to  the  febrile  and  inflammatory  symptoms,  generally  restricts  himself, 
as  far  as  may  be,  to  the  employment  of  demulcents.  These,  by  pass- 


INHALATION. 


221 


ing  over  the  top  of  the  larynx,  soothe  the  mucous  membrane  with 
which  they  come  in  contact,  and,  by  contiguous  sympathy,  the 
soothing  influence  is  propagated  to  the  part  of  the  bronchial  mucous 
membrane  labouring  under  irritation. 

Almost  every  division  of  medicinal  agents  may  become  expecto- 
rant, according  to  the  precise  condition  of  the  system  generally,  or 
of  the  pulmonary  organs  particularly ; and  hence  we  find  an  expec- 
torant effect  equally  from  depletives,  and  from  tonics  and  excitants  ; 
from  narcotics  and  counter-irritants ; and  from  nauseants  and 
emetics. 

inhala'tions. 


Fig.  30. 


But  although  the  existence  of  any  internal  expectorant — acting 
through  the  stomach  and  the  circulation  on  the  lining  membrane  of 
the  air  passages  — may  be  doubted,  there  is  a mode  of  exhibiting 
remedies,  so  that  they  may  come  Fig.  29. 

into  immediate  contact  with  the 
bronchial  mucous  membrane,  so 
as  to  modify  its  functions  effec- 
tively,— through  the  introduc- 
tion of  different  agents  by  inha- 
lation. In  this  way,  soothing 
or  relaxing  vapours  may  be 
made  to  act  upon  the  inflamed 
membrane,  especially  after  the 
violence  of  inflammatory  action 
has  been  previously  somewhat 
subdued  by  appropriate  anti- 
phlogistics ; accordingly,  under 


such  circumstances,  the  vapour 
of  hot  water  is  employed  with  much  advantage,  and,  in  cases  of 
asthma,  relief  is  occasionally  obtained  by  the  addition  of  some  vola- 
tile oil,  as  by  inhaling  the  vapour  from  a hot  infusion  of  chamomile 
flowers.  With  the  same  view,  ether  is  occasionally  added.  In  some 
cases  of  asthma,  there  appears  to  be  a condition  of  the  pneumogas- 
tric  nerves  somewhat  resembling  paralysis,  which  excitants,  intro- 
duced in  the  manner  referred  to,  are  as  ^vell  adapted  to  remove  as 
any  other  agents.  The  vapours  of  burning  substances,  as  of  tar  and 
resin,  are  occasionally  inhaled,  and  they  may  be  employed  with  ad- 
vantage in  chronic  bronchitis,  when  the  inflammation  is  of  an  asthe- 
nic character,  or  when  the  activity  of  the  inflammation  has  passed 
away,  and  the  copious  secretion  from  the  membrane  is  the  most  an- 
noying symptom.  The  vapours  of  boiling  tar  were,  at  one  time, 
strongly  recommended  by  Sir  A.  Crichton  in  consumption,  but  ex- 
perience has  shown  that  not  much  reliance  can  be  placed  upon  them 
in  that  fatal  malady  ; and  many  of  the  cases  of  benefit,  derived 
from  such  inhalation,  have  probably  been  of  the  kind  just  referred 
to  — cases  of  chronic  bronchitis. 

19* 


222 


SPECIAL  EXPECTORANTS. 


The  practice  of  smoking  the  roots  of  stramonium  in  asthma,  and 
other  pulmonary  affections,  has  long  existed,  and  frequently  essential 
benefit  is  derived  from  it.  , There  is  something  inexplicably  capri- 
cious in  this  singular  disease.  Whilst  one  asthmatic  cannot  sleep  in 
town,  another  cannot  remain  in  the  country.  A friend  of  the  author, 
a most  respectable  inhabitant  of  Baltimore,  is  unable  to  sleep  at  his 
country  house,  which  is  not  more  than  a mile  and  a half  from  the 
centre  of  the  town.  He  has  tried  the  experiment  frequently,  and  the 
result  has  been  always  the  same.  The  author  knows  another  indi- 
vidual, who  cannot  exist  in  the  impure  atmosphere  of  towns. 
Others,  again,  prefer  a dry,  whilst  many  breathe  more  freely  in  a 
moist  atmosphere.  The  same  thing,  of  course,  applies  to  medicinal 
agents  inhaled  by  the  lungs.  Tobacco  relieves  some,  and  aggra- 
vates the  symptoms  of  others ; but  the  smoke  of  stramonium  agrees 
with  a large  majority  of  persons,  and  at  times  affords  manifest  re- 
lief. When  suffering  under  a severe  attack  of  the  disease,  the  gen- 
tleman, above  referred  to  — as  unable  to  sleep  in  the  country — has 
frequently  made  manifest  to  his  medical  attendant  the  relief  he  de- 
rives from  its  inhalation.  For  this  purpose  he  employs  the  dried 
stalk.  Others  use  the  root,  and  others  the  leaves  only.  (For  simi- 
lar cases,  see  the  author’s  Practice  of  Medicine^  2d  edit.  ii.  328. 
Philad.  1844.) 

It  is,  too,  in  the  way  of  inhalation,  that  the  different  gases  have 
been  used  therapeutically.  They  were  first  proposed  by  the  enthu- 
siastic Beddoes,  and  are  certainly  capable  of  affecting  the  frame  — 
some  as  excitants,  others  as  sedatives;  — but  difficulties,  connected 
with  their  efficient  administration,  and  uncertainty  in  the  results  ob- 
tained, have  led  to  their  almost  total  abandonment.  They  pass 
through  the  bronchial  tubes,  penetrate  the  blood-vessels  by  imbibi- 
tion, and  exert  their  appropriate  agency,  either  on  the  nerves  distri- 
buted to  the  blood-vessels,  or  affect  the  great  nervous  centres  by 
reaching  them  through  the  circulatory  current;  but  such  agents  can- 
not properly  be  ranked  as  expectorants. 


SPECIAL  EXPECTORANTS. 

I.  Excitant  Expectorants. 

1.  SEN'EGA.— SEN'EKA. 

Sen'eka,  Sen'eka  snakeroot  or  Rattlesnake  root^  is  the  root  of  Polyg'- 
ala  Sen'ega  ; Sex.  Syst.  Diadelphia  Octandria  ; Nat.  Ord.  Poly- 
gale0e,  an  indigenous  plant  common  in  every  part  of  the  United  States, 
but  abounding  especially  in  the  Southern  and  Western  portions, 
where  it  is  collected  for  use. 

As  met  with  in  the  shops,  seneka  is  of  different  sizes,  from  that  of 


SCILLA. 


223 


a writing  quill,  to  that  of  the  little  finger,  having  a thick  knotty  head, 
which  exhibits  traces  of  the  numerous  stems.  It  is  contorted,  often 
marked  by  crowded  annular  eminences,  with  a projecting  line  run- 
ning along  its  whole  length.  The  cortical  portion  is  corrugated, 
cracked  transversely,  and  of  a yellowish-brown  or  greyish-brown 
colour.  The  smell  is  strong  and  peculiar  in  the  fresh  root,  but  faint 
in  the  dried ; and  the  taste  is  at  first  sweetish  and  mucilaginous, 
leaving  a peculiar  acrid  sensation  in  the  fauces. 

The  whole  of  the  virtues  are  resident  in  the  cortical  portion,  the 
woody  matter  being  inert,  and  therefore  to  be  rejected,  in  re- 
ducing seneka  to  powder.  These  virtues  are  yielded  to  boiling 
water,  and  to  alcohol,  especially  to  dilute  alcohol.  They  seem  to 
be  partly  dependent  upon  a substance  called  Sen'egin^  Polygalin  and 
Polygalic  acid,  which  has  been  esteemed  by  some  to  be  an  alkaloid  ; 
by  others  an  acid ; and  which,  when  given  to  dogs,  in  the  dose  of 
6 or  8 grains,  has  caused  vomiting,  difficult  respiration,  and  death  in 
three  hours. 

Seneka  has  been  regarded  as  one  of  the  best  of  the  excitant  expec- 
torants ; and  in  the  form  of  syrup  of  senega  is  largely  used  both  in 
hospital  and  private  practice,  especially  by  those  who  prescribe  ac- 
cording to  a system  of  routine,  and  are  guided  by  names  rather  than 
by  phenomena.  It  is  clearly  excitant ; and,  therefore,  not  adapted 
for  facilitating  expectoration  in  affections  of  the  chest  of  an  inflamma- 
tory character.  Yet,  like  the  squill,  it  forms  part  of  a compound 
syrup  — the  Syrujms  scillm  compositus  — associated  with  nauseating 
and  emetic  substances,  which  certainly  fill  contrary  indications  ; and 
— as  elsewhere  remarked — it  is  probable,  that  most,  if  not  all  of 
the  benefit  in  many  cases  derived  from  the  preparation,  is  due  to  the 
nauseants  and  emetics  contained  in  it. 

Dr.  Pereira  assigns  to  seneka  a sphere  of  action,  which  is  inexpli- 
cable ; and  to  the  author- — who  has  employed  it  largely  — incredi- 
ble. “ In  this  country”  (England)  — he  remarks  — senega  is  com- 
paratively little  employed.  It  is  an  exceedingly  valuable  remedy  in 
the  latter  stages  oi  bronchial  ox  pulmonary  inflammation,  when  this  dis- 
ease occurs  in  aged,  debilitated,  and  torpid  constitutions,  and  when 
the  use  of  depletives  is  no  longer  admissible.  It  appears  to  re-es- 
tablish a healthy  condition  of  the  secreting  organs,  to  promote  the 
resolution  of  the  morbid  deposits,  and  to  give  strength  to  the  system. 
I usually  administer  it  in  combination  with  ammonia,  which  appears 
to  me  to  promote  its  beneficial  operation.  Frequency  of  pulse,  and 
a febrile  condition  of  the  system  are  by  no  means  to  be  regarded  as 
impediments  to  the  use  of  this  medicine.” 

Seneka  is  rarely  — if  ever  — given  in  powder.  Should  it  be  de- 
sired to  administer  it  in  this  form,  the  dose  may  be  from  ten  to  twenty 
grains. 

DECOC'TUM  SENTfiJl,  DECOCTION  OF  SM'ERA.  [Senegc2,  cont.  Sj ; Aqua, 
Oiss.  Boil  to  a pint.)  This  decoction  is  by  no  means  as  much  used 


224 


SPECIAL  EXPECTORANTS. 


as  the  syrup,  the  saccharine  matter  of  which  is  itself  demulcent,  and 
therefore  adapted  for  relieving  cough  and  facilitating  expectoration. 
Sugar,  or  liquorice  root,  or  extract  of  liquorice,  may,  however,  be 
added  to  it. 

SYRTPUS  M'EGiE,  SYRUP  OF  SEN'EKA.  [Seneg.  cont.  ^iv  ; Aquce  Oj ; 
Sacchar.  tbj.  Made  into  a syrup,  either  in  the  ordinary  method  or 
by  displacement.)  The  dose  as  an  expectorant  is  f.  to  f.  ^iij. 
It  is  a common  adjunct  to  expectorant  mixtures,  and,  in  too  many 
cases,  for  no  other  reason  than  because  it  bears  the  name  of  an  ex- 
pectorant, without  regard  to  the  pathological  condition,  or  its  adap- 
tation to  it. 

2.  SCILLA.— SQUILL. 

Squill  — the  general  properties  of  which  have  been  detailed, 
(p.  122)  — is  often  prescribed  both  with  excitant  and  sedative  ex- 
pectorants ; yet  the  union  with  the  latter,  in  the  small  doses  in  wdiich 
it  is  usually  exhibited,  cannot  be  philosophical,  inasmuch  as  it  is 
unquestionably  excitant ; and,  therefore,  adapted  for  cases  of  pectoral 
disease,  in  which  there  is  an  absence  of  all  febrile  and  inflammatory 
phenomena,  and  a demand  rather  for  excitant  expectorants  in 
general. 

When  given  as  an  expectorant,  in  powder,  which  is  rarely  the 
case,  it  is  usually  in  the  dose  of  one  grain,  two  or  three  times  a day. 
As,  however,  it  is  a nauseant  in  a sufficient  dose,  it  may  be  adapted, 
in  a larger  quantity,  for  affections  in  which  sedatives  are  needed. 
In  such  cases,  it  must  be  pushed,  until  its  influence  on  the  stomach 
is  exhibited. 

The  Acetum  Scillce  (p.  123)  is  occasionally  prescribed  as  an  ex- 
pectorant, in  the  dose  of  f.  ^ss.  to  f.  5j  ; but  by  no  means  so  frequently 
as  the  Oxymel  123);  and  the  syrups — simple  and  compound, 
(p.  123) ; the  former  in  the  dose  of  f.  5j  to  f.  5ij  ; the  Syrupus  Scillce 
in  the  dose  of  a fluidrachm  or  two  ; and  the  Syrupus  Scillce  Compo- 
situs  or  Hive  Syricp,  in  the  dose  of  twenty  or  thirty  drops. 

The  Tinctura  Scillcv  (p.  123)  is  rarely  given  alone  ; but  is  often 
added  to  pectoral  mixtures.  Its  dose  is  from  twenty  drops  to  a 
drachm. 

PIL'ULT  SCILLiE  COMPOS'ITiE,  COMPOUND  PILLS  OF  SQUILL.  {ScilL  in 
pulv.  5j  ; Pulv.  Zingib.;  Pulv.  Ammoniac.  5ij  5 Saponis,  :^iij  ; 
Syrup,  q.  s.  to  be  divided  into  120  pills.)  The  dose  of  this  is  from 
5 to  10  grains. 

A M M ONF  A C UM.— A M M O'N  I AC. 

The  botanical  history  of  ammoniacum  has  been  a matter  of  uncer- 
tainty. Recently,  however,  owing  to  the  researches  of  observers  in 
India,  it  has  been  referred  to  Dore'ma  Ammoni' acum  ; Sex.  Syst. 
Pentandria  Digynia  ; Nat.  Ord.  UmbellifercE,  a native  of  Persia,  of 
which  it  is  the  concrete  juice.  The  whole  plant  contains  a large 
quantity  of  a milky  juice,  which  oozes  out,  whenever  punctures  are 


AMMONIACUM. 


225 


made,  even  at  the  ends  of  the  leaves.  It  would  appear,  however, 
that  these  are  never  made  artificially,  but  that  innumerable  beetles 
pierce  the  plant  in  all  directions ; and,  when  dry,  the  ammoniac  is 
picked  of!’,  and  collected.  Dr.  Pereira  states,  that  he  has,  in  his 
museum,  the  upper  part  of  the  apparently  flowering  stem,  about  ten 
inches  long,  with  lumps  of  ammoniac  sticking  to  it  at  the  origin  of 
every  branch. 

Ammoniac,  as  met  with  in  commerce,  usually  comes  from  Bom- 
bay, but  sometimes  from  the  Levant.  It  is  either  in  the  slate  of 
tears,  or  in  lump.  The  former  is  in  more  or  less  spheroidal  tears, 
but  often  in  larger  pieces,  of  an  irregular  shape.  Externally,  they 
are  of  a yellowish  colour,  and  whitish  within.  At  ordinary  tempera- 
tures, they  possess  considerable  hardness,  but  soften  under  the  heat 
of  the  hand. 

Lump  ammoniac  consists  of  whitish  tears,  imbedded  in  a sub- 
stance of  a darker  colour,  and  containing  numerous  extraneous  mat- 
ters, — as  seeds,  fragments  of  vegetables,  and  dirt.  The  odour  of 
both  varieties  is  peculiar,  and  by  no  means  agreeable ; and  the  taste 
nauseous,  bitter  and  somewhat  acrid. 

Ammoniac  is  a gum-resin,  which  has  been  subjected  to  analysis 
by  many  chemists,  and  found  to  consist  of  about  70  per  cent,  of  resin, 
and  about  20  of  gum.  It  contains  also  a volatile  oil,  which  is  sepa- 
rable by  distillation  with  water.  With  this  fluid,  it  forms  a prepa- 
ration, which  is  officinal  — the  mistura  ammoniaci.  The  alcoholic 
solution,  which  is  transparent,  becomes  milky  on  the  addition  of  water. 

Ammoniac  has  been  long  employed  as  an  expectorant  of  the  ex- 
citant class,  and,  consequently,  in  cases  in  which  there  was  little  or 
no  inflammatory  action.  It  would  not  seem,  however,  that  its  ex- 
citant properties  are  active,  and,  from  the  author’s  experience,  it  is 
not  entitled  to  the  credit  that  has  been  assigned  it  in  chronic  bron- 
chitis, and  catarrhal  affections  in  general.  Such,  indeed,  appears  to 
be  the  prevalent  belief,  if  we  judge  by  the  much  smaller  employ- 
ment of  the  drug  now  than  formerly. 

The  dose  of  ammoniac  is  generally  stated  to  be  from  ten  grains  to 
thirty,  in  pill.  It  is  rarely  given  in  this  simple  form,  but  in  combi- 
nation with  other  reputed  expectorants,  as  in  the  Pilulce  Scillce 
Composite  of  the  Pharmacopoeias  of  Edinburgh  and  the  United  States, 
or  the  Pilulce  Ipecacuanhce  Compositce  of  the  London  Pharmacopoeia, 
[Pulv.  Ipecac,  comp,  ^iij ; recente  exsiccat.,  aa^j; 

Mucilag.  acacice,  q.  s.  ut  fiat  massa.  Dose,  five  grains  to  ten.) 

MISTU  RA  AMMOIV'IACI,  AMMO'NIAC  MIXTURE.  {Ammoniac,  ^ij ; AqucB,  Oss.) 
This  mixture  was  formerly  called  Lac  Ammoni' ad,  owing  to  its 
white  appearance.  The  gum  of  the  gum-resin  forms  a mucilage,  by 
which  the  resinous  portion  is  suspended.  The  greater  part  of  re- 
sinous matter  subsides,  however,  on  standing.  When  given  alone 
in  pectoral  affections,  the  ordinary  dose  is  one  or  two  table-spoon- 
fuls. It  not  unfrequently  forms  a vehicle  for  other  agents,  as  Tincture 
of  Opium,  Syrup  of.Seneka,  &c. 


226 


SPECIAL  EXPECTORANTS. 


4.  MYROX'YLON.  — BALSAM  OF  PERU. 

Balsam  of  Peru  is  the  juice  of  Myrox'ylon  Peruif'erum,  or  Myro- 
spermhim  Peruif  erum : Sex.  Syst.  Decandria  Monogynia,  Nat. 
Ord.  Leguminosse,  which  is  indigenous  in  Peru,  New  Grenada,  Co- 
lumbia, and  Mexico. 

In  regard  to  its  history,  there  is  some  uncertainty.  It  has  been 
affirmed,  that  there  are  two  modes  of  obtaining  it — one  by  incisions 
made  into  the  bark  of  the  tree,  and  the  other  by  boiling  the  branches 
and  trunk  in  water  ; — the  former  yielding  a white  liquid  balsam  ; 
the  latter  a blackish-red  liquid.  The  former,  it  is  said,  may  be  pre- 
served for  years  in  the  fluid  state ; but  if  deposited  in  calabashes, 
which  is  commonly  done  in  the  mountains  of  Tolu,  after  some  time 
it  condenses,  and  hardens  into  resin  ; and  is  then  termed  dry  white 
balsam  or  balsam  of  Tolu  ; whilst  the  extract,  made  by  boiling  the 
bark  in  water,  is  blackish,  remains  liquid,  and  is  known  by  the  name 
of  black  Peruvian  balsam.  There  seems  still,  however,  to  be  a 
doubt,  whether  the  black  Peruvian  balsam  of  the  shops  be  prepared 
by  coction.  The  quantity  of  balsam  of  Peru  on  which  duty  was  paid 
in  England,  in  the  year  1839,  was,  according  to  Dr.  Pereira,  825  lbs. 

Balsam  of  Peru  is  transparent,  of  a deep  reddish-brown  colour, 
and  of  the  consistence  of  molasses.  It  has  a fragrant  aromatic  odour  ; 
and  a hot  and  bitter  taste.  It  is  soluble  in  alcohol,  and  miscible 
with  water  by  means  of  mucilage.  Its  specific  gravity  is  variously 
stated,  from  1.14  to  1.16.  It  is  rarely  adulterated.  When  sub- 
jected to  analysis,  it  yields  88  per  cent,  of  resin,  12  of  benzoic  acid, 
and  a trace  of  volatile  oil.  Prolonged  boiling  in  water  removes  from 
it  the  benzoic  acid,  but  nothing  else. 

Balsam  of  Peru  was  at  one  time  much  used  as  an  excitant,  both 
in  external  and  internal  ulcerations ; and  hence  it  has  been  pre- 
scribed as  an  expectorant  in  phthisis ; also  in  chronic  bronchitis, 
and  wffierever  a gentle  excitant  is  needed.  The  dose  is  f.  3ss.  to 
f.  3i.  dropped  on  sugar,  mixed  with  molasses,  or  diffused  in  water  by 
means  of  mucilage  or  yolk  of  egg. 

5.  TOLUTA/NUM.— BALSAM  OF  TOLU. 

Balsam  of  Tolu  is  now  considered  to  be  the  juice  of  Myrox'ylon 
Toluif'erum;  Sex.  Syst.  Decandria  Monogynia:  Nat.  Ord.  Legu- 
minosse,  which  is  indigenous  in  the  mountains  of  Tolu  especially. 
It  is  obtained  by  making  incisions  into  the  trunk  of  the  tree,  collect- 
ing the  juice  as  it  exudes  in  appropriate  vessels,  and  allowing  it  to 
concrete.  It  is  commonly  imported  in  little  calabashes  ; and  it  does 
not  appear  to  differ  from  the  concrete  white  Peruvian  balsam,  which, 
indeed,  as  stated  above,  is  termed  balsam  of  Tolu.  It  is  imported 
chiefly  from  Carthagena. 

When  it  first  arrives  in  the  country  it  is  usually  soft  and  tena- 
cious ; but,  when  kept,  becomes  hard  and  brittle,  somewhat  like 
resin.  It  is  transparent,  of  a yellowish-brown  colour,  has  a highly 


STYRAX. 


227 


fragrant  odour,  and  a sweetish,  not  disagreeable  taste.  It  is  very 
soluble  in  alcohol,  ether,  and  the  essential  oils,  and  yields  its  benzoic 
acid  to  boiling  water.  Its  chemical  composition  is  similar  to  that  of 
balsam  of  Peru. 

Balsam  of  Tolu  is  employed  as  an  expectorant  in  the  same  cases 
as  balsam  of  Peru,  and  is  far  more  frequently  prescribed.  It  has 
never  appeared  to  the  author  to  possess  any  special  agency  in  chronic 
bronchitis,  but  it  makes  an  agreeable  adjunct  to  cough  mixtures  in 
the  form  of  the  Syrup  of  Tolu.  In  chronic  catarrhal  affections,  the 
inhalation  of  the  vapour  of  the  ethereal  solution  is  said  to  have  been 
of  benefit. 

The  dose  is  from  gr.  x.  to  gr.  xxx.  repeated  from  time  to  time. 
It  may  be  given  in  the  form  of  an  emulsion  made  with  mucilage  of 
gum  arabic.  {Tolutan.  5i ; Mucilag.  acacice  f.  §ss.  ; Syrupi  f.  5iij  ; 
Aqu(2  f.  ^v.  M.) 

TINCTU^RA  TOLUTA'NI,  TINCTURE  OF  TOLU.  ( Tolutan.  giij ; Alcohol  Oij.) 
It  is  sometimes  added  to  pectoral  mixtures,  but  is  chiefly  employed 
in  the  formation  of  the  syrup. 

SYRmS  TOLUTA'NI,  SYRUP  OF  TOLU.  {Tind.  Tolut.  f.  |i ; Syrup. 
Oiss.)  This  is  a very  common  adjunct  to  pectoral  mixtures,  to  which 
it  appears  to  communicate  no  virtues,  but  improves  their  flavour. 
Yet  MM.  Trousseau  and  Pidoux  affirm,  that  they  have  cut  short  by 
it  acute  bronchitis,  ‘‘  which  had  reached  the  first  septenary,”  and 
which,  they  think,  would  doubtless  have  gone  on  for  a month  or  six 
weeks  without  the  aid  of  this  precious  agent.”  In  infants,  it  ap- 
peared to  them  of  immense  advantage  in  pulmonary  catarrh,  almost 
at  the  very  onset  of  the  affection,  and  still  more  “ when  the  state  of 
irritation,  dryness  and  turgescence  of  the  mucous  membranes  having 
been  allayed,  the  catarrhal  secretion  began  to  be  effected.” 

Balsam  of  Tolu  is  an  ingredient  in  the  Tinctura  Benzoini  Composita 
of  the  Pharmacopoeia  of  the  United  States. 

6.  STYRAX.— STORAX. 

Storax  is  the  concrete  juice  of  Styrax  officindU;  Sex.  Syst.  De- 
candria  Monogynia  ; Nat.  Ord.  Styracese,  (Bindley,)  a small  tree, 
which  is  indigenous  in  Asiatic  Turkey  and  Greece,  and  is  cultivated 
in  the  southern  parts  of  Europe.  From  incisions  made  into  the  tree, 
or  from  the  punctures  of  an  insect,  the  storax  exudes.  No  precise 
knowledge  exists  as  to  the  mode  in  which  it  is  procured  ; as  the 
natives  of  the  country,  who  collect  it,  will  not  communicate  their 
mode  of  procedure.  It  is  imported  into  Great  Britain  from  Trieste. 

Two  varieties  are  met  with  in  the  shops ; — common  storax^ — styrax 
calami’ta  of  some,  and  liquid  storax.  The  former  occurs  in  brittle 
cakes,  several  pounds  in  weight,  of  a reddish-brown  colour,  and 
having  a fragrant,  agreeable,  balsamic  odour,  and  an  aromatic  taste. 
It  appears  to  be  composed  of  saw-dust,  cemented  by  a resinous  mat- 
ter. It  can  be  easily  reduced  to  coarse  powder,  and  in  this  state  is 
often  met  with  in  the  shops.  The  latter  has  been  supposed  to  be 


228 


SPECIAL  EXPECTORANTS. 


derived  by  decoction  from  Liquidam’har  styracif'lua ; but  Dr.  Wood 
remarks,  that  some  of  the  genuine  juice  of  Liquidambar,  brought 
from  New  Orleans,  which  he  had  an  opportunity  of  inspecting,  had 
an  odour  entirely  distinct  from  that  of  Storax.  Moreover,  it  has 
been  recently  affirmed,  that  the  liquid  storax,  or  storax  oil^  is  ob- 
tained at  Cos  and  Rhodes  from  styrax  officinale.  By  means  of  lon- 
gitudinal incisions,  the  bark  of  the  stems  is  removed  in  small  narrow 
strips,  which,  when  pressed  together,  readily  adhere  by  means  of 
their  glutinous  juice,  and  in  this  way,  they  are  made  up  in  bundles 
of  about  two  pounds  each.  These  are  then  subjected  to  pressure  in 
warm  presses,  by  which  means  a liquid  storax  is  obtained,  which, 
according  to  Landerer,  cited  by  Pereira,  has  the  consistence  of  but- 
ter, a gray  colour,  and  an  odour  resembling  that  of  vanilla.  It  is 
doubtful,  however,  whether  this  be  the  liquid  storax  of  the  shops, 
which  is  of  a brown,  almost  black  colour  on  the  surface  which  is  ex- 
posed to  the  air,  but  of  a light  greenish-grey  colour  within  and  of  a 
smell  somewhat  resembling  that  of  the  Balsam  of  Peru. 

Dr.  Pereira  has  described  not  less  than  ten  varieties  of  storax,  but 
the  above  are  all  that  can  concern  the  pharmacologist,  — the  others 
being  rarely  met  with  in  commerce,  and  most  of  them  never  seen 
on  this  side  the  Atlantic. 

When  subjected  to  analysis,  storax  yields  a trace  of  volatile  oil, 
about  50  per  cent,  of  resin,  and  one  or  two  per  cent,  of  benzoic 
acid,  the  presence  of  which  entitles  it  to  a place  among  the  balsams. 
It  is  so  mixed  — in  the  state  in  which  it  is  met  with  in  the  shops  — 
with  extraneous  matters,  that  it  requires  to  be  purified : this  is  done 
according  to  a process  directed  in  the  British  and  American  Phar- 
macopoeias for  STYRAX  PURIFICA'TA,  or  pu’rified  storax,  which  consists 
in  dissolving  the  soluble  matters  in  alcohol,  straining  the  solution,  and 
distilling  off  the  alcohol,  until  the  storax  acquires  the  proper  con- 
sistence. The  volatile  portion  is  not  driven  off  by  the  heat  of  boil- 
ing alcohol,  yet,  as  suggested  by  Dr.  Christison,  it  may  be  well  not 
to  carry  the  concentration  too  far,  in  order  that  the  fragrant  principle 
may  be  better  retained,  and  the  extract  be  of  a fitter  consistence  for 
forming  pills. 

Storax,  like  some  of  the  articles  already  mentioned,  has  been  con- 
sidered to  possess  stimulant  properties,  which  are  more  particu- 
larly directed  to  the  mucous  surfaces,  especially  to  the  bronchial 
membrane;”  but  it  may  be  doubted,  whether  either  it  or  any  of  the 
articles  referred  to,  be  possessed  of  such  powers.  Like  the  other 
balsams,  however,  it  is  excitant,  and  might  be  employed  in  chronic 
catarrhal  affections  of  the  bronchia,  in  which  excitant  expectorants 
are  needed.  It  is  not  often  prescribed  on  this  side  the  Atlantic,  or 
indeed  any  where  ; notwithstanding  that  the  British  colleges  have  a 
formula  for  the  Pilulcc  Styracis  Composites,  which  consist  essentially 
of  strained  storax  and  opium,  and  are  occasionally  given  in  chronic 
pulmonary  affections  to  relieve  cough  ; but  are  more  valuable,  per- 
haps, as  a means  of  administering  opium  to  persons  who  are  preju- 


BENZOINUM. 


229 


diced  against  it,  the  name  and  the  balsamic  character  of  the  storax 
completely  masking  the  narcotic. 

Should  it  be  desired  to  administer  storax,  the  dose  may  be  ten  to 
twenty  grains  two  or  three  times  a day,  — or  either  the  common,  or 
the  liquid  storax  may  be  suspended  in  water  by  means  of  mucilage 
of  gum  arabic. 

Storax  enters  into  the  composition  of  the  Tinctura  Benzoini 
Composila  of  the  Pharmacopoeias. 

7.  BENZO'INUM.— BEN'ZOIN. 

Benzoin  or  Ben’jamin  is  the  concrete  juice  of  Slyrax  Benzoin; 
ihe.  Be7ijamin  Tree;  Sex.  Syst.  Decandria  Monogynia ; Nat.  Ord. 
Styracese,  — a tall  tree,  indigenous  in  Sumatra,  Borneo,  Siam  and 
Java.  It  is  obtained  in  Sumatra,  when  the  tree  is  about  six  years 
old,  by  making  incisions  in  the  bark,  and  allowing  the  juice  to  re- 
main for  three  months.  Fresh  incisions  are  made  after  the  concrete 
juice  has  been  removed,  until  the  tree  is  exhausted,  and  usually 
dies.  The  juice  which  exudes  at  the  first  incision  is  the  best,  and 
said  to  be  alone  exported  to  Europe.  Each  tree  yields  about  three 
pounds  of  Benzoin  annually  for  ten  or  twelve  years. 

Benzoin,  which  is  met  with  in  commerce,  is  usually  imported  into 
England  from  Singapore  or  Calcutta.  In  1839,  duty  was  paid  there 
on  108  cwt.  (Pereira.)  It  is  of  different  degrees  of  fineness,  and 
is  sometimes  distinguished  into  firsts^  seconds^  and  thirds  ; or  more 
commonly,  perhaps,  into  firsts  and  seconds^  or  fine  and  coarse;  and 
sometimes  the  finer  kinds  are  termed  Siam  Benzoin  ; the  commoner, 
Calcut'ta  Benzoin.  The  former  contains  white  grains,  which  have 
the  appearance  of  fragments  of  blanched  almonds,  that  are  seated 
in  a deeper  reddish-brown  ground  ; the  latter  is  more  uniform,  ana 
has  a dark-reddish  brown  or  almost  black  colour.  Both  are  firm 
and  pulverisable,  of  tin  agreeable,  fragrant  balsamic  odour,  and  a 
slightly  aromatic  taste.  Boiling  water  takes  up  a little  benzoic  acid  ; 
alcohol  dissolves  all  except  the  impurities,  and  the  solution  is  ren- 
dered milky  by  the  addition  of  water. 

Its  chief  constituents  are  resin,  benzoic  acid,  and  a trace  of  vola- 
tile oil,  — the  amygdaloid  benzoin  containing  80.7  per  cent,  of  resin, 
and  19.8  of  benzoic  acid  ; the  coarser  or  brown  benzoin,  78.4 
per  cent,  of  resin,  and  19.7  of  benzoic  acid. 

Benzoin  had  at  one  time  a much  higher  reputation,  as  an  internal 
remedy,  than  it  has  at  present.  Like  the  balsams  and  gum-resins, 
it  was  regarded  as  an  excitant  expectorant;  and,  as  a relic  of 
antiquity,  it  still  holds  its  place  in  one  or  two  formulae.  Should  it 
be  prescribed  at  all,  it  ought  to  be  in  pulmonary  affections,  which 
are  unaccompanied  by  febrile  or  inflammatory  excitement.  It  will 
be  seen  afterwards,  that  it  is  employed  as  a topical  expectorant  in 
the  form  of  fumigation  ; and  it  is  one  of  the  ingredients  of  the  fumi- 
gate ry  pastilles,  which  are  largely  used  in  oriental  climes ; and  of  the 
fumigating  compounds  employed  in  the  Romish  church. 

VOL.  I. — 20 


230 


SPECIAL  EXPECTORANTS. 


Benzoin  is  scarcely  ever  — if  ever — administered  in  substance. 
The  dose  of  the  powder  may  be  from  ten  to  thirty  grains. 

TINCTU'RA  BENZO'INI  COMPOS  ITI,  COMPOCND  TINCTURE  OF  BENZOIN.— (Ben- 
zoin.  §iij:  Styracis  puriUcat.  §ij  ; Tolutan.  §j.  Jiloes,  in  pulv.  §ss.; 
Jilcohol.  Oij.)  The  dose  of  this  preparation,  as  an  excitant  expecto- 
rant, is  f.  3ss.  to  f.  5ij.  It  is  rarely,  however,  employed.  As  the 
resin  is  precipitated  on  the  addition  of  water,  it  may  be  made  into 
an  emulsion  by  means  of  mucilage  of  gum  arabic.  It  is  chiefly  used 
as  an  external  excitant  to  ulcers. 

8.  AC"IDUM  BENZOICUM.  — BENZO'IC  ACID. 

Benzoic  acid,  formerly  termed  Flowers  of  Ben’jamin,  exists  in  the 
various  balsamic  substances,  as  benzoin,  storax,  tolu  balsam,  &c. 
It  is  also  met  with  in  the  vanilla  pod,  and  in  certain  animal  sub- 
stances, as  in  the  urine  of  children  and  of  the  herbivora  under  certain 
states  of  decomposition.  In  Pharmacy,  it  is  obtained  from  benzoin 
by  sublimation.  Benzoin,  in  coarse  powder,  thoroughly  mixed  with 
an  equal  weight  of  fine  sand,  is  put  into  a proper  vessel,  and,  by 
means  of  a sand  bath,  with  a gradually  increasing  heat,  it  is  sublimed 
until  vapours  cease  to  rise.  The  sublimed  matter  is  deprived  of  oil 
by  pressure  in  bibulous  paper,  and  is  again  sublimed. 

Benzoic  acid,  as  met  with  in  the  shops,  is  in  light  white  feathery 
crystals,  of  an  agreeable  odour^  and  an  acrid  feebly  acid  taste.  It 
is  fusible,  and  wholly  volatilises  if  cautiously  heated  ; is  soluble  in 
about  two  hundred  parts  of  cold  water,  and  in  about  twenty-five 
parts  of  boiling  water  ; is  very  soluble  in  alcohol,  and  readily  dissolves 
in  solution  of  potassa,  from  which  it  is  precipitated  by  chlorohydric 
acid. 

The  therapeutical  action  of  benzoic  acid  is,  doubtless,  excitant, 
and  it  has  been  imagined,  by  Dr.  Pereira,  and  others,  that  its  influ- 
ence is  principally  directed  to  the  mucous  surfaces,  and,  “ especially 
to  the  aerian  membrane.”  The  author  has  not  had  the  slightest 
reason  for  believing  in  this  special  affinity,  and  such  would  appear 
to 'be  the  general  feeling  of  the  profession,  as  it  is  now  scarcely  used 
except  in  one  or  two  officinal  preparations,  in  which  it  seems  to  be 
retained  only  from  old  prepossessions  and  associations. 

When  given  alone  as  an  excitant  expectorant,  its  dose  is  from  ten 
to  thirty  grains ; but  the  author  has  never  administered  it,  or  seen  it 
administered,  as  such.  It  is  occasionally  used,  as  will  be  seen  here- 
after, as  a topical  expectorant ; and  forms  part  of  the  Tinctura  opii 
camphor ata  or  Paregoric  elixir^  in  which  it  probably  exerts  no  bene- 
ficial agency. 

9 COPA'IBA. 

Copaiba  — whose  general  properties  are  described  under  Exci- 
tants — has  been  much  extolled  by  many  respectable  practitioners 
in  cases  of  chronic  bronchitis,  and  in  every  form  of  pulmonary 
affection,  in  Which  a gentle  excitant  is  necessary.  It  is  not  adapted 


MYRRHA. 


231 


for  cases  in  which  there  is  febrile  or  inflammatory  action.  Dr.  La 
Roche,  of  Philadelphia,  has  adduced  strong  testimony  in  favour  of  it 
in  diseases  of-  the  bronchial  mucous  membrane  of  the  atonic  kind, 
as  well  as  in  diseases  of  the  mucous  membranes  in  general.  It  may 
be  given  in  the  dose  of  twenty  or  thirty  drops  on  sugar,  or  be  made 
into  an  emulsion.  [Copaib.  f.  ^iss  ; Mucilag.  Acacice^  f.  ^vj  ; Syrup. 
f.  §ss.;  AqucB^  f.  ^ivss.  — M.  Dose,  one  fourth  part  four  times  a day.) 

10.  MYR'RHA.  — MYRRH. 

Myrrh  is  the  concrete  juice  of  Balsamaden' dron  Myrrha;  Sex, 
Syst.  Octandria  Monogynia : Nat.  Ord.  Tere- 
binthaceae  ; a small  tree,  which  is  indigenous  in 
Gison,  on  the  borders  of  Arabia  Felix.  It 
exudes  from  the  bark  of  the  tree,  and  con- 
cretes there.  Formerly,  the  finest  kind  of 
myrrh  was  imported  from  Turkey,  and  an 
inferior  variety  from  India ; but  it  would 
seem  that,  at  the  present  day,  it  almost  all 
comes  from  the  latter  country.  A considerable 
quantity  of  it  is  consumed ; for,  in  the  year 
1839,  according  to  Dr.  Pereira,  no  less  than 
216  cwt.  paid  duty  in  England. 

The  myrrh  of  the  shops  is  in  irregular  pieces 
of  various  sizes,  differing  in  colour,  — the  best 
pieces  being  of  a reddish-yellow,  and  trans- 
lucent. It  is  brittle,  and  capable  of  reduction 
to  powder,  and„has  a peculiar,  somewhat 
agreeable  odour,  and  a bitter  aromatic,  but,  in  the  author’s  opinion, 
disagreeable  taste.  The  best  myrrh  should  possess  these  qualities  ; 
but  other  varieties  are  occasionally  met  with,  — a second  quality, 
which  is  in  distinct  small  tears  or  grains,  — and  a third  quality, 
which  occurs  in  pieces  of  a darker  colour  than  the  best,  and  which, 
according  to  Dr.  Pereira,  are  probably  coarser  myrrh  mixed  with 
impurities. 

Myrrh  is  only  partially  soluble  in  water,  alcohol,  and  ether ; the 
gum  enables  the  water  to  suspend  a part  of  the  resin.  Dilute  alcohol 
dissolves  some  of  the  resin,  and  less  of  the  gum  ; whilst  alcohol  dis- 
solves the  resin  and  volatile  oil,  leaving  the  greater  part  of  the  gum  ; 
and  as  the  two  first  are  the  active  ingredients  in  myrrh,  alcohol  is 
generally  used  as  the  menstruum.  The  most  recent  analysis  afforded 
2.6  per  cent,  of  volatile  oil,  27.8  of  resin,  and  63.7  of  gum. 

Myrrh  has  been  employed  as  an  expectorant.  From  its  consti- 
tuents, it  is  obviously  excitant,  and,  therefore,  not  adapted  for  any 
pulmonary  affection  in  which  there  is  vascular  excitement.  It  has 
been  occasionally  prescribed  in  the  same  cases  as  the  other  excitant 
expectorants,  but  is  not  much  used  at  the  present  day,  and  never, 
perhaps,  except  in  combination.  The  dose  is  from  gr.  x.  to  gr.  xxx. 
in  the  form  of  pill.  It  may  also  be  made  into  an  emulsion,  but  its 
taste  is  an  objection  to  it  in  this  form. 


Fig.  31. 


Balsamadendron  Myrrha. 
a.  A leaf.  b.  The  fruit. 


232 


SPECIAL  EXPECTORANTS. 


TINCTU'RA  MYRRHiE,  TINCTURE  OF  MYRRH.  {Myrrh,  conins.  |iv;  Alcohol. 
Oiij.)  Tincture  of  myrrh  possesses  all  the  virtues  of  the  drug,  but  it 
is  scarcely  ever  prescribed  internally.  The  dose,  as  an  expectorant, 
is  stated  to  be  f.  5ss.  to  f.  5j. 

Myrrh  enters  into  the  composition  of  various  officinal  formulze,  as 
of  the  Mistura  Ferri  Composita  ; the  Pilulce  Aloes  et  Myrrhce  ; the 
PilulcB  Ferri  Composites  ; and  the  Pilules  Rhei  Composites  of  the  Phar- 
macopoeia of  the  United  States. 

11.  ASSAFCE'TIDA.— ASSAFET'IDA. 

Assafetida,  — whose  general  properties  are  described  under  Anti- 
spASMODics — is  excitant,  and  therefore  adapted  for  cases  in  which 
there  is  a want  of  due  innervation  in  the  respiratory  apparatus,  and, 
at  the  same  time,  no  febrile  or  inflammatory  action.  In  hooping- 
cough,  it  has  been  regarded  as  beneficial ; but  the  author  has  sub- 
jected it  to  extensive  trials,  and  has  not  been  able  to  say  positively, 
that  any  markedly  good  effects  have  resulted  from  it.  In  this  dis- 
ease, it  doubtless  acts  by  virtue  of  the  new  impression  it  makes  on 
the  nerves,  and  is  more  properly  an  antispasmodic. 

In  old  cases  of  chronic  bronchitis,  and  of  chronic  cough  accompa- 
nied by  nervous  erethism,  occurring  in  any  disease,  it  is  prescribed. 
The  dose  is  from  gr.  v.  to  ^ss.  in  the  form  of  pill ; but  it  is  rarely 
given  alone,  in  this  shape,  as  an  expectorant. 

MISTU'RA  ASSAFCE'TIDiE,  ASSAFETIDA  MIXTURE.  (Assafestid.  5ij ; Aques, 
Oss.)  The  gum  of  the  assafetida  is  sufficient  to  cause  the  suspension  of 
the  resin,  so  that  the  Lac  Assafeetides  — as  it  was  formerly  called  — 
contains  the  main  virtues  of  the  gum-resin.  In  the  thoracic  affections 
for  which  assafetida  is  deemed  proper,  this  is  a good  form  of  adminis- 
tration. For  children,  it  may  be  sweetened  with  sugar  ; and  although 
it  may  be  disagreeable  to  them  at  first,  they  soon  become  accustomed 
to,  and  even  fond  of,  it.  The  dose  to  an  adult  is  f.  ^ss  to  f.  Jij  ; to 
a child,  one  or  two  tea-spoonfuls. 

GAL'BANUM. 

Galbanum, — whose  general  properties  are  described  under  Anti- 
spasmodics,  — possesses  the  same  excitant  virtues  as  the  other,  so 
called,  antispasmodic  gum-resins,  and  is  presumed  to  hold  an  inter- 
mediate place  between  ammoniacum  and  assafetida  as  an  expecto- 
rant. It  is  very  rarely,  however,  used  as  such  ; — on  this  side  of 
the  Atlantic,  never  perhaps.  The  dose  is  from  gr.  x.  to  xxx.  in  the 
form  of  pill,  or  made  into  an  emulsion. 

13.  AL'LTUM.— GARLIC. 

The  bulb  of  AVlium  Sati’vum^  Sex.  Syst.  Hexandria  Monogynia  ; 
Nat.  Ord.  Liliaceae  (Lindley),  is  a well  known  culinary  article,  and 
although  not  much  used  in  medicine  is  introduced  into  the  Pharma- 
copoeias of  Great  Britain  and  this  country.  Garlic  is  indigenous  in 


INULA. 


233 


the  Southern  countries  of  Europe,  flowering  in  July,  and  is  every 
where  cultivated  in  the  kitchen  gardens. 

The  strong,  peculiar,  irritating  smell,  and  acrid  taste  of  garlic  are 
owing  to  volatile  oil,  separable  by  distillation  with  water,  — six 
drachms  of  which  are  obtained  from  twenty  pounds  of  garlic.  An 
acrid  expressed  oil  can  also  be  separated  from  it.  The  volatile  oil 
has  a very  acrid  taste,  and  strong  smell. 

Like  all  substances  whose  medicinal  virtues  are  dependent  upon 
volatile  oil,  garlic  is  excitant ; and  consequently,  when  employed  as 
an  expectorant,  it  can  only  be  in  cases  where  there  is  no  active  in- 
flammation of  the  lining  membrane  of  the  bronchial  tubes ; and  in 
states  of  the  system  and  of  the  tubes,  in  which  a gentle  excitant  is 
necessary,  as  in  chronic  bronchitis.  In  such  cases,  the  expressed 
juice  may  be  mixed  with  sugar  ; or  the  following  preparation  may 
be  advised  : 

SYRTPUS  AL'LII,  SYRUP  OF  GARLIC.  {Allii  recent,  ^vj ; Acet.  des- 
tillat.  Oj ; Sacch.  ifeij  ; f.  Syrupus.)  The  vinegar  is  used  in  this 
preparation  under  the  idea,  that  it  is  a better  solvent  of  the  active 
principle  than  water,  which  may  be  questioned.  It  is  occasionally 
given  to  children  affected  with  ordinary  catarrh,  in  the  dose  of  a 
tea-spoonful  or  two,  but  is  not  much  prescribed  by  the  physician.  It 
is  an  officinal  preparation  in  the  Pharmacopoeia  of  the  United  States, 
but  not  in  that  of  any  British  College, 

14.  IN'ULA.  — ELECAMPANE', 

Elecampane  is  the  root  of  In'ula  Helen'ium,  Sex.  Syst.  Syngene^ 
sia  Polygamia  Superflua  ; Nat.  Ord.  Composite  Asteroideae,  a large 
handsome  plant,  which  is  indigenous  in  various  parts  of  Europe  ; 
flowering  in  June  and  July.  It  has  become  naturalised  in  this 
country,  and  is  cultivated  in  the  gardens,  and  for  medical  use.  The 
root  is  officinal  in  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States. 

As  met  with  in  the  shops,  the  dried  root  is  usually  in  longitudinal 
or  transverse  slices,  of  a yellowish-gray  colour,  an  aromatic  slightly 
camphoraceous  odour,  and  a warm,  aromatic  and  bitter  taste.  The 
medical  virtues  are  imparted  both  to  alcohol  and  water.  The  root 
has  been  analysed  by  different  chemists,  and  found  to  contain, 
amongst  other  constituents,  a peculiar  aromatic  principle  — to  which 
the  names  HeVenin  and  Elecampane  Camphor  have  been  given  ; 
resin,  the  taste  of  which  is  bitter,  nauseous  and  acrid  ; an  amyla-* 
ceous  substance  termed  In’ulin  and  Al'antin ; and  bitter  extrac-* 
tive. 

From  this  analysis  it  can  be  understood  that  Inula  possesses  the 
medical  virtues  of  the  aromatic  tonics ; but  it  is  rarely  used  except 
as  an  excitant  expectorant  in  pulmonary  catarrh,  and  bronchitic 
affections,  in  which  there  is  no  febrile  or  inflammatory  excitement. 
It  has  had  some  reputation  as  an  eramenagogue,  but  has  outlived  it, 
20^ 


2.54 


SPECIAL  EXPECTORANTS. 


It  may,  like  other  aromatic  tonics,  act  indirectly  in  asthenic  cases  of 
amenorrhoea.  The  decoction  is  the  form  commonly  prescribed. 
(Inul.  ^ss ; AqucB  Oj. — Dose,  f.  ji  tof.  §ij.) 

15.  CREASO'TUM.— CRE'ASOTE. 

Creasote  — whose  properties  are  described  under  Excitants  — 
has  been  used  as  an  excitant  expectorant  in  phthisis  ; but  the  results 
have  been  discordant,  as  might  have  been  anticipated  in  so  in- 
tractable a disease.  On  the  whole  its  employment  has  been  pro- 
ductive of  but  little  advantage.  It  is  probable,  however,  that 
where  there  is  much  secretion  from  the  bronchial  mucous  membrane 
it  may  be  of  service;  yet  in  these  cases.  Tar-water  — Aqua  picis 
liquidce  (see  under  Astringents)  which  is  probably  mainly  indebted 
for  its  efficacy  to  the  creasote  it  contains  — has  been  preferred  by 
some. 


When,  in  the  distillation  of  coal  tar,  the  last  portion  of  the  vola- 
tile oily  product  is  collected  apart  and  left  to  stand,  a quantity  of 
solid,  crystalline  matter  separates,  which  is  principally  composed  of 
Naph'thaline.  This  substance  forms  large,  colourless,  transparent, 
brilliant,  crystalline  plates,  that  exhale  a faint  and  peculiar  odour 
which  has  been  compared  to  that  of  narcissus.  It  melts  at  176°,  and 
boils  at  413°.  It  is  insoluble  in  cold  water,  but  soluble  to  a slight 
degree  at  a boiling  temperature.  Alcohol  and  ether  dissolve  it  rea- 
dily. It  has  been  given  by  M.  Dupasquier  as  an  excitant  expecto- 
rant in  chronic  bronchitis,  in  the  dose  of  from  8 to  30  grains  in  emul- 
sion or  syrup,  repeated  at  intervals  of  a quarter  of  an  hour,  until 
a copious  expectoration  supervenes.  In  psoriasis  and  lepra  vul- 
garis, an  ointment  composed  of  two  scruples  of  concrete  naphthaline 
to  30  of  lard,  proved  successful,  according  to  M.  Emery. 

Of  late,  under  the  name  Naphtha,  and  Wood  JVaphtha,  the  Pyro- 
ace'tic  spirit^  Pyroace'tic  ether  ovAd'etone  has  been  recommended  in 
pulmonary  consumption  by  Dr.  Hastings  and  others,  but  the  evi- 
dence is  far  from  establishing  that  it  is  possessed  of  more  efficacy 
than  creasote  and  the  articles  just  mentioned.  It  is  obtained 
by  carefully  distilling  acetate  of  lead,  and  rectifying  the  crude 
spirit  by  repeated  distillations  from  quick-lime.  It  is  a colourless 
I'impid  liquid,  having  a peculiar  odour  ; a density  of  .792,  and  boils 
at  132°.  As  found  in  the  shops,  its  density,  according  to  Dr.  Bache, 
is  generally  not  lower  than  ,820,  It  mixes  with  water,  ether  and 
alcohol  in  all  proportions. 

The  dose  in  which  it  was  used  by  Dr.  Hastings  — - who  proposed 
it  as  a cure  for  pulmonary  consumption  on  very  inadequate  grounds, 
however  — was  from  ten  to  forty  drops  three  times  a day. 

Like  creasote,  it  may  be  found  serviceable  in  chronic  bronchitis, 
where  an  excitant  expectorant  is  needed. 


ACACIA. 


235 


II.  Demulcent  Ea'pectorants, 


16.  ACA'CIA.  — GUM  AR^ABIC. 

Gum  Arabic  is  the  concrete  juice  of  Aca'cia  vera^  and  other  spe- 
cies of  Acacia : Sex.  Sv^st.  Polygamia  Monoecia  ; Nat.  Ord.  Le- 
guminosse.  The  species  of  Acacia,  which  yield  considerable  quan- 
tities of  gum,  besides  Aca'cia  vera^  a native  of  Arabia  and  of 
Africa  from  Senegal  to  Egypt,  are — the  Aca'cia  Arab'ica,  a native  of 
Senegal,  Egypt,  Arabia  and  India ; the  A.  Karoo,  indigenous  at  the 
Cape  of  Good  Hope  ; the  A.  gummif  era,  native  of  Arabia  and  of 
Africa,  near  Mogadore;  — the  A.  Seyal,  native  of  Egypt  and  Sene- 
gambia ; the  A.  tor'tilis,  and  A.  Ehrenber'gii,  natives  of  Arabia, 
and  the  A.  Senegal,  native  of  Arabia,  and 
Africa  from  Senegal  to  the  Cape  of  Good 
Hope. 

The  gum  generally  exudes  from  the 
Acacise  spontaneously,  and  concretes  on 
the  trunk  and  branches.  At  times,  how- 
ever, incisions  are  made  to  facilitate  its 
flow.  It  commonly  exudes  soon  after  the 
rainy  season  has  softened  the  bark,  and 
made  it  liable  to  split  during  the  succeed- 
ing hot  weather.  It  is  exported  to  this 
country  from  the  Levant,  or  some  of  the 
other  parts  of  the  Mediterranean;  from  Bar- 
bary and  Senegal,  and  from  the  East  Indies,  Cape  of  Good  Hope, 
&c.  According  to  Dr.  Pereira,  duty  was  paid,  in  1839,  on  the  fol- 
lowing quantities  imported  into  England. 

Gum  from  the  East  Indies,  - - - 7,869  cwts. 

Senegal  Gum,  - 24,698 

Other  sorts  of  Gum,  - - - - 7,759 


Fig.  32. 


Total, 40,326 


The  best  gum  arabic,  often  termed  Turkey  gum,  is  in  rounded,  or 
emorphous  pieces ; some  of  them  transparent ; others  more  or  less 
opaque,  with  deep  cracks  extending  through  them.  It  is  usually  of  a 
white  or  yellowish-white  colour.  The  powder  into  which  it  is  readily 
reduced  is  generally  almost  pure  white.  It  is  inodorous,  and  has  a 
very  feeble  taste.  Its  specific  gravity  varies  from  1.316  to  1.482.  It 
is  wholly  soluble  in  water,  forming  a mucilage,  which  is  an  officinal 
preparation.  It  is  insoluble  in  alcohol,  which  throws  it  down  from 
its  aqueous  solution. 

These  are  the  main  qualities  of  the  officinal  gum  arabic.  It  is 
apt,  however,  to  be  mixed  with  other  varieties  of  gum,  which  are 
described  by  the  different  writers  on  pharmacology,  but  which  de- 
mand no  detailed  account  here; — for  example:  1.  The  Bar'bary 


236 


SPECIAL  EXPECTORANTS. 


or  Moroc'co  Gum,  supposed  to  be  the  produce  oi  Aca^cia  gummife- 
ra,  which  is  imperfectly  soluble  in  water : 2.  Gum  Senegal',  ob- 
tained from  several  species  of  acacia,  which  is  by  no  means  as  easily 
pulverisable  as  the  best  gum  arabic.  3.  East  In'dia  (jum,  some  of 
which  resembles  the  best  gum  arabic ; but  other  portions  are  far  more 
difficult  to  pulverise  ; and  4,  the  Cape  Gum,  which  is  of  a very 
inferior  kind. 

Gum  arabic  has  been  subjected  to  analysis  by  Guerin,  and  found 
to  consist  of  79.40  per  cent,  of  pure  gummy  principle,  to  which  the 
Ar' ahin  has  been  given,  and  which  is  wholly  soluble;  of  17.60 
per  cent,  of  water,  and  3.00  of  ashes.  It  contains  no  Bas'sorin  or 
insoluble  gum,  which  exists  in  such  large  quantities  in  Gum  Bas'- 
soRA,  supposed  to  be  the  concrete  juice  of  a mesemhrynnth' emum. 

The  essential  action  of  gum  arabic  is  that  of  a demulcent  to  the 
surfaces  with  which  it  comes  in  contact,  — soothing  the  top  of  the 
larynx  in  catarrhal  affections,  and  the  soothing  influence  being  ex- 
tended downwards  along  the  trachea  and  bronchia  by  continuous 
sympathy.  It  is  sometimes  taken  into,  the  mouth  in  those  affec- 
tions, and  permitted  to  dissolve  slowly,  and  is  the  basis  of  certain 
lozenges,  which  have  attained  celebrity  for  relieving  cough,  and 
facilitating  expectoration.  It  is  a valuable  agent  in  many  cough 
mixtures  into  which  fixed  oil  enters — not  simply  as  a demulcent 
expectorant,  but  to  suspend  the  oil  in  water,  and  form  it  into  an 
emulsion. 

The  dose  of  powdered  gum  arabic  has  been  stated  at  from  5ss. 
to  3j  ; but  it  is  obviously  an  article  the  dose  of  which  can  scarcely  be 
fixed.  It  is  taken  ad  libitum. 

MCCILA'GO  ACACIA, MUCILAGE  OF  GUM  ARABIC,  {Acacice^  in  pulv.  Aqu(z 
hullientis  Oss.)  It  forms  part  of  many  mixtures  for  relieving  cough  ; 
but  is  chiefly  used  as  a vehicle-  to  render  other  substances  miscible 
with  water. 

17.  ALTHiE'A.  — .MARSHMAI/LOW. 

Marshmallow  is  the  root  of  Althce'a  officina'lis.,  Sex.  Syst. 
Monadelphia  Polyandria ; Nat.  Ord.  Malvaceae ; an  herbaceous 
perennial,  which  is  indigenous  in  this  country  as  well  as  in  Europe, 
growing  on  the  borders  of  marshes,  and  especially  of  salt  marshes. 
The  roots  are  collected  in  autumn  ; but  those  that  are  met  with  in 
the  shops  are  chiefly  obtained  from  Europe.  They  are  generally 
deprived  of  epidermis,  and  are  of  a white  colour,  cylindrical  shape, 
and  of  about  the  thickness  of  the  little  finger.  Their  odour  is  fee- 
ble ; taste  sweet  and  mucilaginous.  They  are  light,  woolly  exter- 
nally, and  composed  of  delicate  silky  fibres. 

When  chemically  examined,  theyarefound  to  contain  a little  fecula 
or  starch  ; nearly  20  per  cent,  of  mucilage  ; some  uncrystallisable 
sugar;  and  a crystallisable  principle,  identical  with  the  aspar'agin  of 
asparagus, — besides  other  less  important  constituents. 


AMYGDALA. 


237 


The  virtues  of  marshmallow  are  similar  to  those  of  gum  arabic, 
and  it  has  been  employed  in  the  same  cases,  especially  on  the  con- 
tinent of  Europe.  The  Pate  de  Guimauve  or  Marshmal'low  Paste 
or  Loz'enge  is  a favourite  remedy  in  France  in  hoarseness,  and  catar- 
rhal affections  in  general. 

There  is  no  officinal  preparation  of  the  althaea  in  the  Pharmacopoeia 
of  the  United  States  ; a Decoction  is  officinal  in  the  Edinburgh 
and  Dublin  Pharmacopoeias,  and  a Syrup  in  all  the  British  Pharma- 
copoeias. 

18.  AMYG'DALA.  — ALMONDS. 

The  Pharmacopoeia  of  the  United  States,  as  well  as  those  of  Great 
Britain  and  elsewhere,  admit  both  the  bitter  and  the  sweet  almonds 
as  officinal,  — the  former  being  the  kernels  of  the  fruit  of  Amyg' dalus 
commu'nis^  — variety  ama'ra  ; and  the  latter  of  Amygdalus  communis^ 
— variety  dulcis ; — a tree  in  Sex.  Syst.  Icosandria  Monogynia  ; Nat. 
Ord.  Rosaceae  (Jussieu),  — Tribe,  Amygdalese,  which  is  indigenous 
in  Barbary  and  Syria,. and  is  cultivated  in  the  southern  parts  of 
Europe,  whence  it  has  been  introduced  into  this  country,  but  with- 
out any  advantage,  except  as  an  ornament.  The  general  opinion  is, 
that  both  varieties  of  almonds  are  furnished  by  a tree  of  the  same 
species ; some  botanists,  however,  believe  that  they  are  produced 
by  distinct  species,  and  according  to  Dr.  Christison,  Nies  von  Esen- 
beck  states,  that  he  had  been  informed  on  good  authority,  that  in  the 
Palatinate  bitter  almonds  are  not  unfrequently  gathered  from  the  sweet 
almond  tree. 

The  almond  is  so  well  known  as  not  to  require  a description. 
Sweet  Almonds  are  imported  from  Spain  and  the  south  of  France. 
The  Jordan  Almonds,  which  are  best,  come  from  Malaga ; other 
varieties,  — according  to  Busby,  — are  the  Valentia,  the  Barbary, 
and  the  Italian.  The  bitter  almonds  are  brought  chiefly  from 
Mogadore.  One  variety  only  is  known  in  commerce.  Both  sorts, 
when  triturated  with  water,  furnish  a copious  white  emulsion. 

The  composition  of  the  sweet  and  bitter  almond  is  interesting  to 
the  chemist ; butnot  much  so  to  the  therapeutist.  The  sweet  almond 
contains  about  54  per  cent,  of  a bland  fixed  oil — the  O'leum  Amyg'- 
dala:,  — 24  per  cent,  of  a variety  of  soluble  vegetable  albumen, 
termed  emul'sin  or  syn'aptase^  which  is  the  principle  that  suspends 
the  oil  in  almond  emulsion  ; sugar,  gum,  moisture  and  integuments. 
The  bitter  almond  contains  rather  less  fixed  oil  and  more'  synaptase, 
and  has,  besides,  a peculiar  principle,  called  Amyg' dalin^  which  is 
interesting  in  its  chemical,  but  not  in  any  therapeutical  relation. 
It  contains,  moreover,  the  elements  of  a bitter  volatile  oil,  which 
does  not  exist  in  the  bitter  almond,  but  is  speedlily  developed  when 
water  comes  in  contact  with  it.  It  has  been  found,  that  when  bitter 
almonds  are  deprived  of  their  amygdalin,  they  are  incapable  of 
yielding  volatile  oil ; hence  it  has  been  inferred,  that  water  acts 
upon  this  principle  and  generates  the  evil.  Yet  amygdalia  and 


238 


SPECIAL  EXPECTORANTS. 


water  produce  no  oil,  unless  emulsin  or  synaptase  be  likewise  pre- 
sent. Certain  it  is,  that  bitter  almonds  yield  no  volatile  oil  on  pres- 
sure, which  ought  to  be  the  case  did  it  exist  in  them;  as  the  volatile 
oil  is  soluble  in  the  fixed  oil ; nor  do  they  yield  oil  to  alcohol  or 
ether.  This  oil  is  highly  poisonous,  and  contains  hydrocyanic  acid, 
for  which  — as  elsewhere  shown  — certain  preparations  from  the 
bitter  almonds  are  occasionally  used  as  substitutes. 

Both  varieties  of  almonds  are  demulcents  by  virtue  of  the  oil  they 
contain,  and  it  has  been  conceived,  that  the  volatile  oil,  developed 
by  the  combination  of  water,  amygdalin  and  emulsin,  may  com- 
municate to  the  emulsion  of  bitter  almonds  virtues  similar  to  those 
of  hydrocyanic  acid,  and  not  possessed  by  the  emulsion  of  sweet 
almonds ; — and  whence,  that  the  former  may  be  adapted  for  cases  in 
which  a demulcent  expectorant  is  needed  equally  with  hydrocyanic 
acid.  Often,  however,  the  bitter  almond,  in  pharmaceutical,  as  in 
culinary  preparations,  is  employed  solely  to  communicate  an  agree- 
able flavour  to  the  compound. 

mSTU'RA  AMYGDALAE,  ALMOND  MIXTURE.  {Amygdal.  dulc.  gss ; Acacice 
pulv.  5ss ; Sacchar.  ^ij  ; Aquce  destillat.  f.  §viij.)  Almond  mixture 
is  an  elegant  demulcent  expectorant,  much  prescribed  for  allaying 
cough  in  catarrhal  affections,  under  the  name  of  almond  emulsion  and 
almond  milk.  It  is  a good  vehicle  for  the  administration  of  other 
agents,  as  laudanum,  paregoric,  antimonial  wine,  &c.  It  may  be 
tal^en  almost  ad  libitum;  but  the  ordinary  dose  is  from  f.  fo 

f-  5"j- 

SYR'UPUS  AMYG'DALJ],  SYRUP  OF  ALMONDS.  {Amygdal.  dulc.  ifej ; Amyg- 
dal.  amar.  giv;  Aquce^  Oiij  ; Sacchar.  Ibvj.)  This  is  the  syrup  of 
orgeat.,  which  has  been  introduced  from  the  French  Codex  into  the 
last  edition  of  the  Pharmacopoeia  of  the  United  States.  It  may  be 
used  in  the  same  cases  as  the  almond  emulsion,  and  is  an  agreeable 
drink  in  sickness. 

19.  O'LEUM  AMYG'DAL^.  — OIL  OF  ALMONDS. 

Almond  oil  is  the  fixed  oil  of  the  kernels  of  Amyg’dalus  commu'nis. 
(p.  237.)  It  is  obtained  by  expression  from  either  bitter  or  sweet 
almonds,  but  more  commonly  from  the  former,  on  ^ account  of  their 
cheapness,  as  well  as  the  greater  value  of  their  residuary  cake.  The 
average  produce  is  from  48  to  50  lbs.  from  one  cwt.  of  almonds. 
From  what  has  been  said  elsewhere,  it  will  be  obvious,  that  in  the 
case  of  bitter  almonds,  the  contact  of  water  must  be  avoided.  As 
met  with  in  the  shops,  oil  of  almonds  is  transparent  and  without 
colour,  or  of  a slightly  yellow  tinge  ; nearly  inodorous,  and  of  a 
bland,  oleaginous  taste.  It  is  soluble  in  ether,  and  in  six  parts  of 
boiling,  or  twenty-five  parts  of  cold  alcohol.  Its  density  varies  from 
.917  to  .920.  The  cake,  left  after  the  expression  of  the  oil,  when 
ground,  forms  Almond  powder^  which  is  used  for  keeping  the  skin  of 
the  hands  soft. 


OLEUM  OLIV^. 


239 


Almond  oil  is  sometimes  prescribed  in  the  form  of  the  common 
oleaginous  mixture,  in  cases  of  catarrh,  as  a demulcent  expectorant. 
( Olei  amygdal.  acacice;  Syrup,  aa  f.  §ss  ; Aquce.,  f.  givss. 

M.  Dose,  a table-spoonful,  when  the  cough  is  troublesome.)  To 
this  mixture  may  be  added  sulphate,  acetate,  or  muriate  of  morphia, 
or  Tinctura  opii  camphor ata^  &c.,  according  to  the  indications. 
An  emulsion  might  also  be  made  by  the  substitution  of  alkalies,  or  of 
the  yolk  of  egg,  for  the  mucilage  ; but  neither  is  so  agreeable. 

Formerly,  equal  parts  of  syrup  of  violets  or  syrup  of  roses and 
almond  oil.,  was  a favourite  laxative  mixture  for  infants,  and  it  has 
been  used  likewise  in  the  catarrhal  affections  of  that  age  — simple 
syrup  being  substituted  for  either  of  the  syrups  mentioned.  F ormerly, 
too,  almond  oil  was  more  frequently  employed  than  at  present  in  the 
formation  of  linctuses  to  allay  cough.  Of  these,  the  following  is  a 
form  ; U. — Confect,  Rosce  canin.  ; Syrup.  Papaveris  ; 01.  amygdal. 
aa  f.  ^ss.  M.  Dose,  a tea-spoonful  or  two  when  the  cough  is  trouble- 
some.) These  linctuses  are  rarely  employed,  at  the  present  day,  in 
this  country. 

20.  OXEUM  OLrViE  — OLIVE  OIL. 

Olive  oil  is  the  expressed  oil  of  the  fruit  of  O'lea  Europce'a., 
Europe’ an  olive;  Sex.  Syst.  Decandria 
Monogynia;  Nat.  Ord.  Oleaceee ; a tree 
which  is  supposed  to  have  been  origi- 
nally from  Asia,  but  has  been  cultivated, 
so  far  as  history  extends  back,  in  the 
south  of  Europe. 

The  finest  olive  oil  is  obtained  from 
ripe  olives,  by  crushing  them  immedi- 
ately in  a mill,  and  subjecting  the  pulp 
or  pericarp  to  gentle  pressure.  By  aug- 
menting the  pressure,  a somewhat  in- 
ferior— but  still  good  — article  is  ob- 
tained. An  inferior  kind,  again,  is  got 
by  pouring  boiling  water  on  the  residuum, 
to  dissolve  its  mucilage,  and  subjecting 
it  again  to  gentle  pressure ; and  still 
stronger  pressure  forces  out  a turbid, 
impure  oil,  which  is  fit  only  for  the 
soap-maker.  An  inferior  oil  is  like- 
wise obtained  by  allowing  the  olives  to  ferment  for  some  days  before 
they  are  subjected  to  pressure. 

The  most  esteemed  oil  is  that  made  in  Aix,  and  termed  Provence 
Oil.  Florence  Oil  or  Salad  Oil  is  a fine  kind,  imported  from 
Leghorn  in  flasks.  Gen'oa  Oil  is  likewise  a fine  variety.  The 
Gallip'oli  Oil,  Sic"ily  Oil,  and  SpAnish  Oil,  are  inferior  varieties ; 
the  last  being  esteemed  the  worst  of  all. 


240 


SPECIAL  EXPECTORANTS. 


The  quantity  of  olive  oil  consumed  is  very  great.  In  the  year 
1839,  duty  was  paid  on  12,374  tons.  It  is  an  article  so  well  known 
as  not  to  need  any  description.  When  good,  it  is  almost  devoid  of 
smell,  and  has  a bland,  slightly  sweet  taste.  Its  density  at  77°  Fahr. 
is  about  0,911.  It  is  soluble  in  one  and  a half  times  its  weight  of 
ether,  and  very  slightly  soluble  in  alcohol.  By  exposure  to  air,  it 
readily  becomes  rancid,  but  more  slowly  than  other  fixed  oils. 

It  is  said  to  be  much  subject  to  adulteration  with  poppyseed  oil, 
rapeseed  oil  and  other  cheap  oils ; but  as  these  oils  congeal  less 
readily  than  olive  oil,  the  adulteration  may  be  detected  by  reducing 
the  temperature  to  the  freezing  point ; or,  the  test  suggested  by 
Poutet,  and  adopted  by  the  Edinburgh  Pharmacopoeia,  may  be  used. 
When  pure  olive  oil  is  mixed  wdth  a solution  of  mercury  in  nitric 
acid,  prepared  by  heat,  the  whole  becomes,  in  a few’  hours,  a firm 
fatty  mass,  from  the  action  of  the  hyponitrous  acid  in  the  solution. 
But  if  even  so  small  a quantity  as  5 per  cent,  of  any  other  oil  be 
present,  the  consolidation  is  much  more  firm  and  more  tardy ; and  if 
the  proportion  amounts  to  12  per  cent.,  the  foreign  oil  floats  on  the  sur- 
face of  a pulpy  mass,  for  several  days  before  showing  any  tendency 
to  concrete. 

As  a demulcent  expectorant,  olive  oil  is  used  in  the  same  cases, 
and  form  of  preparation,  as  almond  oil. 

21.  CETA'CEUM.— SPERMACETI. 

Spermaceti  is  a peculiar  concrete  substance,  approaching  in  cha- 
racter the  concrete  fixed  oils  or  fats,  w’hich  is  obtained  from  Physe'^ 
ter  Macroceph'alus,  or  great-headed  Cach'alot  or  spermaceti  whale^ 
order  Cetacea,  w^hich  inhabits  the  Pacific  ocean,  and  the  Indian  and 
Chinese  seas.  It  is  found  in  various  parts  of  the  animal’s  body, 
being  dissolved  in  small  proportion  in  the  blubber.  The  head,  how- 
ever, contains  that  which  we  meet  with  in  commerce.  It  is  mixed 
with  oil,  in  a large  cavity  in  the  upper  jaw,  anterior  to,  and  quite 
distinct  from,  the  cavity  that  holds  the  brain.  There  are  two  places 
in  the  head,  which  contain  it,  betw^een  which  the  nostrils  pass  ; and 
both  cavities  are  divided  into  numerous  cells,  which  are  filled  with 
a milky  fluid,  amounting  in  a large  whale  to  about  50  cwt.  The 
contents  of  these  cavities  are  removed  by  buckets,  and  boiled,  to 
separate  the  oleaginous  from  the  solid  matter.  In  this  fluid,  the 
spermaceti  crystallises  as  it  cools,  and  is  separated  in  an  impure 
state  by  draining  off  the  oil,  and  subjecting  what  remains  to  strong 
pressure.  The  crude  spermaceti  is  purified  by  melting  it  in  water, 
and  skimming  off  the  impurities.  It  is  then  melted  in  a w^eak  solu- 
tion of  potassa,  and  finally  melted  a third  time  by  a gentle  heat,  after 
w^hich  it  is  solidified  in  proper  moulds,  when  it  forms  the  spermaceti 
of  the  shops.  It  generally  contains  a small  portion  of  oil,  wdiich 
may  be  removed  by  boiling  in  alcohol.  The  spermaceti,  then  called 
ceiin^  is  absolutely  pure. 

The  spermaceti  of  the  shops  is  a white  concrete  substance,  of  a 


SACCHARUM. 


241 


foliaceous  texture,  without  taste,  and  almost  without  smell.  It  may 
be  readily  reduced  to  powder,  by  the  addition  of  a few  drops  of 
rectified  spirit.  It  is  insoluble  in  water ; slightly  soluble  in  cold 
alcohol,  but  much  so  when  the  alcohol  is  at  the  boiling  temperature. 
It  is  greatly  soluble  in  ether,  and  readily  so  in  the  oils — fixed  or 
volatile. 

Spermaceti  possesses  the  demulcent  properties  of  the  bland  fixed 
oils,  but  it  is  rarely  given  internally.  When  this  is  desired,  it  may 
be  made  into  an  emulsion  with  yolk  of  egg,  or  mucilage^  the  sperma- 
ceti being  first  pulverised  by  the  addition  of  a few  drops  of  alcohol. 

22.  SAC'CHARUM.— SUGAR. 

This,  in  the  Pharmacopoeia  of  the  United  States  (1842),  is  the 
officinal  name  for  the  sugar  of  Sac'charum 
officina'rum  or  Sugar  cane,  refined. 

Sac'charum  officina'rum;  Sex.  Syst.  Tri- 
andria  Digynia ; Nat.  Ord.  Graminese,  is 
cultivated  in  the  tropical  regions  of  both  the 
old  and  new  .world.  Its  native  country  can- 
not now  be  discovered,  but  it  is  supposed  to 
have  come  originally  from  the  East.  It  is 
the  expressed  juice  of  the  ripe  canes,  clarified 
and  allowed  to  crystallise  or  grain.  The 
sugar,  when  put  in  casks  and  allowed  to 
drain,  forms  Muscava'do,  brown,  or  raw 
SUGAR ; and  the  uncrystallised  portion  is 
MOLAs'sES.  Six  pounds  of  juice,  in  the  East 
Indies,  and  eight  pounds  in  the  West  Indies, 
according  to  Dr.  Christison,  yield  one  pound  of  raw  sugar. 

Raw  sugar  contains  various  impurities,  from  which  it  can  be  puri- 
fied ; — by  eiutriation  with  a little  water,  solution  in  water  heated 
by  steam,  clarification  with  blood  and  alumina,  filtration  through 
animal  charcoal,  concentration  in  vacuo  at  150°,  crystallisation,  and 
displacement  of  the  impure  syrup  in  the  crystalline  mass  by  passing 
pure  syrup  through  it.  (Howard,  cited  by  Christison.)  The  product 
is  White  Sugar,  Reiuned  Sugar,  or  Loaf  Sugar  — Sac'charum  of 
the  Pharmacopoeia  o-t  the  United  States  — of  which  79  per  cent,  may 
be  obtained  from  good  Muscavado  sugar.  The  uncrystallisable 
syrup  in  this  process  is  Treacle  or  Sugar-house  Molasses. 

It  is  not  necessary  to  describe  further  the  processes  for  forming 
various  kinds  of  sugar,  or  to  dwell  upon  its  properties.  It  may  be 
well,  however,  to  remark,  that  by  the  slow  evaporation  of  a solution 
of  sugar  in  water,  a crystalline  product  is  obtained,  called  Sugar 
Candy.  Barley  Sugar  is  obtained  by  evaporating  syrup  to  a state 
of  great  concentration,  taking  care  not  to  empyreumatise  it,  and  then 
allowing  it  to  cool.  Taffy  is  made  by  evaporating  a mixture  of 
sugar  and  butter ; and  Candy  by  boiling  syrup  or  molasses  for  a few 
minutes,  with  the  addition  of  a little  butter  to  prevent  it  from  burn- 
VOL.  I.  — 21 


Fig.  34. 


Saccharurn  officinartitn. 


•242 


SPECIAL  EXPECTORANTS. 


ing,  and  flavouring  with  lemon,  peppermint,  &c.,  should  this  be 
desired. 

^^ugar  is  very  soluble  in  water,  and  its  saturated  solution,  called 
Syrup,  is  an  officinal  preparation.  It  is  also  soluble  in  alcohol,  but 
not  in  ether. 

In  the  United  States,  according  to  M’Culloch,  from  70,000  to 
80,000  tons  of  sugar  are  consumed  annually. 

Sugar  is  one  of  the  best  of  the  demulcent  expectorants,  and  forms 
a part  of  most  cough  mixtures  on  that  account.  In  the  form  of 
candies,  lozenges,  &c.,  it  is  much  used  in  cases  of  tickling  cough. 
A mixture  of  syrup  and  olive  oil  in  equal  portions  is  a common  pre- 
scription in  the  catarrhal  affections  of  infants  ; and  the  various  offici- 
nal syrups  that  are  used  as  expectorants,  as  Syrupus,  Syrupus 
Syrupus  arriygdalce^  Syrupus  scillce,  S.  scillce  compositus,  S.  senegcBy 
and  S.  tolutaniy  owe  a part  of  their  efficacy  to  their  saccharine  con- 
stituent. ^ 

SYR  UPUS,  SYRUP.  [Sacchar.  ibiiss ; JiqucBy  Oj.)  Simple  syrup  is 
rarely  used  alone  as  a demulcent  expectorant,  but  it  forms  part  of 
Riany  mixtures  that  are  prescribed  for  allaying  cough. 

23.  GLYCYRRHI'ZA— LIQ'UORICE  ROOT. 

Liquorice  Root  is  the  root  of  GlycyrrM za  glahra  or  Common 
Liq’uorice;  Sex.  Syst.  Diadelphia  Decandria ; Nat.  Ord.  Legumi- 
nosee ; a perennial  herbaceous  plant,  which  is  indigenous  in  the  south 
of  Europe,  and  is  cultivated  at  Mitcham,  in  Surrey,  England,  and 
at  other  places,  for  medicinal  use.  Much  of  the  root  which  is  im- 
ported into  this  country  is  said  to  come  from  the  ports  of  Messina 
and  Palermo  in  Sicily.  (Wood  & Bache.) 

Liquorice  Root  or  Stick  Liquorice  of  the  shopSj  is  in  long  cylin- 
drical pieces  of  varied  thickness,  from  a few  lines  to  more  than  an 
inch;  of  a grayish-brown  colour  externally,  and  yellow  internally. 
It  has  little  or  no  odour,  but  a remarkably  sweet  taste,  with  a slight 
degree  of  acrimony.  Its  main  chemical  constituents  are  Glyc'yrrhi- 
ziuy  Glyc’ion  or  Liquorice  Sugai'y  which  belongs  to  the  uncrystallis- 
able  sugars,  that  are  not  susceptible  of  vinous  fermentation  ; and  a 
resinous  oil,  to  which  it  owes  the  slight  degree  of  acrimony  which 
it  possesses.  The  acridity  seems  to  be  seated  in  the  epidermis,  so 
that,  for  medical  use,  the  epidermis  should  be  removed. 

The  active  principle  of  liquorice  root  is  soluble  in  water. 

Liquorice  root  is  one  of  the  most  agreeable  demulcent  expecto- 
rants, and  is  generally  given  in  the  form  of  decoction,  either  alone 
or  combined  with  other  demulcents.  It  is  not  often,  however,  pre- 
scribed by  the  practitioner,  and  as  a domestic  remedy  is  more  used 
in  the  form  of  the  extract.  It  enters  into  the  composition  of  Con- 
fectio  SenncCy  Decoctum  Sarsaparillce  Compositumy  Infusum  Liniy 
PilulcB  Hydrargyriy  and  Syrupus  Sarsaparillce  Compositus  of  the  Phar- 
macopoeia of  the  United  States. 

EXTRAC'TUM  GLYCYRRni'ZJ],  EXTRACT  OF  LlffUORICE.  Liq'uorice  JuicCy 


LINUM. 


243 


Spanish  Juice,  Ital'ian  Juice,  Black  Sugar,  is  amongst  the  prepara- 
tions in  the  London  and  Dublin  Pharmacopceias ; but  as  it  is  altoge- 
ther imported  into  this  country,  it  has  been  properly  placed  in  the 
Materia  Medica  list  of  the  Pharmacopoeia  of  the  United  States.  It 
is  prepared  in  the  same  manner  as  the  ordinary  watery  extracts,  by 
boiling  the  root,  and  evaporating  the  strained  decoction.  Spanish 
juice  is  said  to  be  prepared  in  Catalonia  from  Glycyrrhi'za  glabra; 
the  Italian  from  G.  echina’ta.  ^ 

About  4,059  cwt.  of  foreign  extract  of  liquorice,  according  to  Dr. 
Pereira,  paid  duty  in  England  in  the  year  1839. 

That  which  is  used  in  this  country  is  said  to  be  brought  from  Leg- 
horn and  Messina.  It  comes  in  cylindrical  or  flattened  rolls,  covered 
with  bay  leaves,  and  when  good  is  very  black,  dry,  brittle,  and  en- 
tirely soluble  in  water.  It  is  rarely,  however,  wholly  pure,  as  usually 
met  with.  Refi'ned  liquorice  is  obtained  by  dissolving  the  im- 
ported extract  in  water,  filtering  the  solution,  and  evaporating.  The 
Pont'efract  or  Pomfret  Loz'enges  are  made  of  refined  liquorice. 

Extract  of  liquorice  is  taken  into  the  mouth,  and  allowed  to  dis- 
solve slowly  as  a demulcent  expectorant  in  cough. 

TROCHIS'CI  GLYCYRRlirZl  ET  OTII,  TROCHES  OF  LIQUORICE  AND  OPIFM. 
{ Opii,  in  pulv.  Jss  ; Glycyrrhiz.  in  pulv.,  Sacchar.  in  pulv.,  Jlcacice, 
in  pulv.  aa  5^;  01.  Anisi,  f.  ^ij.)  These  lozenges  combine  the 
demulcent  virtues  of  liquorice,  sugar,  and  gum  arabic,  and  the  ano- 
dyne properties  of  opium.  They  are,  consequently,  well  adapted  to 
allay  cough,  where  opium  is  admissible.  Each  lozenge  contains 
about  one-seventh  of  a grain  of  opium. 

A preparation  similar  to  these  troches  is  known  in  Philadelphia 
under  the  name  of  Wistar’^s  Cough  Lozenges. 

24.  LINUM.  — FLAXSEED. 

Flaxseed,  Linseed  or  Lintseed  is  the  seed  of  Linuni  usitatis' simum, 
common  flax;  Sex.  Svst.  Pentandria  Pentagynia; 

Nat.  Ord.  Lineae — Linaceae,  (Lindley),  an  annual 
plant,  extensively  cultivated  in  various  parts  of  the 
globe,  which  flowers  in  June  and  July,  and  whose 
seeds  ripen  in  August.  Both  the  seeds  and  their  ex- 
pressed oil  are  officinal.  The  seeds  are  oblong,  oval, 
flattened  on  the  sides,  with  acute  edges,  pointed  at 
one  end,  smooth,  glossy,  brown  externally  and  yel- 
lowish-white wuthin,  devoid  of  smell,  and  of  an 
oily  mucilaginous  taste.  The  coat  of  the  seeds  is 
mucilaginous  ; the  nucleus  oily.  The  entire  seed 
yields  about  a sixth  of  dry  mucilage,  and  a fifth  of 
oil.  Linseed  meal  is  the  oil  cake,  which  remains 
after  the  expression  of  linseed  oil,  ground  to  pow- 
der. It  abounds  in  mucilage,  and  is  extensively 
used  in  the  formation  of  poultices.  For  this  pur- 
pose, it  is  better  than  the  ground  seeds,  which  contain  oil,  and  are 
liable  to  become  rancid. 


244 


SPECIAL  EXPECTORANTS. 


Flaxseed  is  not  given  in  substance.  The  ^most  common  form  of 
administration  as  a demulcent  expectorant  is  the 

INFU 'SUM  LINI,  INFU  SION  OF  FLAXSEED.  {Lini^  §ss;  Glycyrrhiz.  coi\\. 
^ij  ; Aquce  bullient.  Oj.)  Flaxseed  tea  is  a common  domestic 
remedy  in  catarrhal  affections.  The  formula  given  above  is  officinal 
in  the*  Pharmacopoeia  of  the  United  States.  It  is  rendered  more 
palatable  by  the  addition  of  sliced  lemon.  The  dose  may  be  from 
1'.  ^ij;  to  f.  jiv,  but  it  is  generally  taken  ad  libitum. 

25.  TRAGAOAN'THA.  — TRAG'ACANTH. 

Tragacanth  or  Gum  Trag'acanth  of  Gum  Dragon  is  referred  to 
Hstrag'alus  verus  by  the  Pharmacopoeia  of  the  United  States  (1842) ; 

but  it  is  generally  supposed  to  be  the 
concrete  juice  of  various  species  of 
Astragalus;  Sex.  Syst.  Diadelphia 
Decandria ; Nat.  Ord.  Leguminosee. 
The  greater  part,  however,  of  that 
which  is  met  with  in  commerce  would 
seem  to  belong  to  Astrag' alus  verus^  a 
native  of  Persia.  Astrag' alus  gum'- 
mifer.^  of  Lebanon  ; A.  Cre'ticus^  of 
Mount  Ida  in  Crete,  and  A.  strobilif- 
erus.,  of  Koordistan,  are  also  said  to 
produce  it.  It  exudes  spontaneously 
from  the  stems  and  branches  during 
the  summer  season,  and  concretes  there.  It  is  imported  from  Smyrna 
and  other  ports  of  the  Levant.  The  entries  of  tragacanth  for  home 
consumption,  in  Great  Britain,  in  1831  and  1832,  were,  according 
to  M’Culloch,  at  the  rate  of  45,836  lbs.  a year. 

As  seen  in  the  shops,  it  is  in  small  contorted  pieces  of  the  most 
irregular  shapes  ; of  a yellowish-brown  colour  ; semi-transparent  or 
translucent ; hard  ; tough  ; devoid  of  odour  and  taste  ; difficult  of 
pulverisation,  except  at  a temperature  of  100°  or  120°  Fahr.,  (Chris- 
tison),  or  at  a freezing  temperature,  (Wood  & Bache.)  Its  specific 
gravity  is  1.384.  With  cold  water  as  well  as  hot  it  forms  a muci- 
lage ; but  a portion  only  appears  to  be  dissolved  ; the  remainder, 
after  a time,  being  precipitated.  Chemical  analysis  shows  it,  indeed, 
to  be  composed  of  common  gum,  identical  with,  or  at  all  events  re- 
sembling, the  Ar'ahm  of  gum  arabic,  which  has  been  termed  Traga- 
canth'in  or  .ddragant'm^  sol'uble  gum  or  Ar'abin  of  trag'acanth ; and 
of  Bas'sorin  or  insol'uble  gum  of  trag' acanth  ; the  former,  according 
to  one  analysis,  constituting  57  per  cent.  ; the  latter  43  per  cent. 
Gum  tragacanth  is  wholly  insoluble  in  -alcohol.  From  its  property 
of  swelling  up  in  water,  and  forming  a soft  adhesive  j)aste,  it  is  much 
used  in  the  shop  of  the  apothecary  for  pasting  labels,  &c. 

Dr.  Pereira  describes  two  kinds  of  tragacanth,  — Flaky  or 
Smyrna  Trag'acanth, — that  usually  found  in  English  commerce,  and 
which  occurs  in  moderately  large,  broad,  thin  pieces,  marked  with 


Fig.  36. 


Astragalus  verus. 


SASSAFRAS. 


245 


arched  or  concentric  elevations  : and  the  Ver'miform  or  More'a 
Trag'acanth,  common  on  the  continent  of  Europe,  and  occurring 
in  small,  twisted,  filiform,  spiral  pieces. 

Gum  tragacanth  possesses  the  same  properties  as  gum  arabic,  but 
it  is  very  rarely  employed  as  a demulcent.  It  is  more  commonly 
used  as  a means  of  administering  heavy  powders  by  reason  of  the 
gveat  viscidity  it  imparts  to  water : and  in  pharmacy  in  the  forma- 
tion of  troches  or  lozenges.  Should  it  be  desired  to  administer  the 
powder,  the  dose  may  be  from  ^ss.  to  ^ij.  The  Pulvis  Traga- 
can'tha:  Compos'itus  of  the  London  and  Edinburgh  Pharmacopoeias, 
which  consists  of  tragacanth^  gum  arabic^  starchy  and  sugar ^ is  chiefly 
used  as  a vehicle  for  the  exhibition  of  heavy  active  powders  to  chil- 
dren, and  is  occasionally  given  as  a demulcent. 

MUCM'GO  TRAGACAN  ™,  MU  CILAGE  OF  TRAG  ACANTH.  ( Tragacanth.  5! ; 
Jlquce  bullient.  Oj.)  This  mucilage  is  rarely  given  internally.  It  is 
chiefly  used  in  pharmacy  in  the  formation  of  troches  or  lozenges,  as 
of  the  Trochisci  ipecacuanhcE,  T.  magnesice,  and  T.  menthce  piperitce  of 
the  Pharmacopoeia  of  the  United  States. 

26.  SES'AMUM.  — BENNE. 

Benne,  which  is  in  the  secondary  list  of  the  Pharmacopoeia  of 
the  United  States,  is  the  leaves  of  Ses'amum  Orienta'le  or  Benne 
plant;  Sex.  Syst.  Didynamia  Angiospermia;  Nat.  Ord.  Bignoniae, 
Pedaliaceae,  (Bindley,)  an  annual  plant,  which  is  a native  of  India, 
but  has  been  cultivated  in  various  parts  of  the  world,  and  is  sup- 
posed to  have  been  introduced  from  Africa  into  the  Southern  states, 
as  well  as  into  the  West  Indies,  by  the  negroes. 

The  seeds  afford,  on  expression,  a fixed  oil  — OTEUM  SES'AMl  or 
Benne  oil — which  is  in  the  secondary  list  of  the  Pharmacopoeia  of 
the  United  States.  It  resembles  olive  oil  in  its  properties,  and  is 
used  for  the  same  purposes. 

When  one  or  two  fresh  .benne  leaves  are  stirred  in  about  half  a 
pint  of  cool  water,  a quantity  of  gummy  matter  is  imparted  to  the 
water,  which  soon  renders  it  viscid.  When  the  leaves  are  dried, 
they  may  be  put  into  hot  water.  The  mucilage,  thus  formed,  pos- 
sesses the  same  properties  as  the  mucilage  of  gum  arabic,  and  may 
be  used  as  a demulcent  expectorant. 

27.  SAS'SAFRAS  MEDUL'LA.— SAS"SAFRAS  PITH. 

The  pith  of  the  stems  of  Laurus  sas^safras, — whose  general  pro- 
perties are  described  under  Excitants — is  met  with  in  the  shops  in 
slender  cylindrical  pieces,  which  are  very  light  and  spongy ; and 
have  a mucilaginous  taste,  with  the  flavour  of  sassafras.  They  con- 
tain a large  quantity  of  gummy  matter,  which  is  imparted  to  water, 
so  as  to  form  a mucilaginous  solution  : this  is  used  whenever  muci- 
lages are  required  internally,  and,  therefore,  as  a demulcent  expec- 
torant. The  mucilage  may  be  made  for  internal  use,  by  adding  a 
drachm  of  theynVA  to  a pint  of  boiling  water ; but  it  is  not  often  pre- 
21^ 


240 


SPECIAL  EXPECTORANTS. 


scribed  iiileriially.  It  is  most  frequently  used  as  a soothing  applica- 
tion in  ophthalmia. 

28.  ULMUF.— SLIP'PERY  ELM  BARK. 

The  inner  bark  of  Ulmus  fulva.  Slippery  elm  or  Red  elm ; Sex. 
Syst.  Pentandria  Digynia ; Nat.  Ord.  Amentace2e  or  Ulmaceae, 
abounds  in  mucilaginous  matter,  which  it  readily  imparts  to  water. 
Slippery  elm  is  indigenous  in  this  country,  flourishing  in  every  part 
of  the  United  States  to  the  north  of  Carolina,  but  most  so  in  the 
Western  states.  The  inner  bark  is  found  in  the  shops,  freed  from 
the  epidermis,  in  long,  nearly  flat  pieces,  which  may  be  reduced  to 
powder  by  grinding.  Its  smell  is  peculiar,  but  not  agreeable  ; and 
its  taste,  when  chewed,  is  mucilaginous. 

Slippery  elm  bark  is  almost  always  given  in  the  form  of  tea  or  in- 
fusion. A mucilage  may,  however,  be  made  by  stirring  the  powder 
in  hot  water. 

INFU'SllM  IMI,  INFUSION  OF  SLIP'PERY  ELM  BARK.  {Vlmi,  concis.  et  con- 
tus.  ; Aquce  bullient.  Oj.)  This  may  be  taken  as  a demulcent  ex- 
pectorant in  catarrhal  affections  ; but  it  is  not  much  used. 

29.  CETRA’RIA.— ICELAND  MOSS. 

Cetra’ria  Islan’dica^  Lichen  hlan'diciis  or  Iceland  moss ; Sex.  Syst. 

Cryptogamia ; Nat.  Ord.  Lichenes, — Lich- 
enacese,  (Lindley,)  is  found  in  the  northern 
latitudes  of  both  continents,  and  is  said  to 
be  abundant  on  the  mountains  and  in  the 
sandy  plains  of  New  England.  It  is  im- 
ported into  England  from  Hamburg  and 
Gothenburg,  and  is  said  to  be  the  produce 
of  Norway  and  Iceland.  In  1839,  15,933 
pounds,  according  to  Dr.  Pereira,  paid  duty 
in  England.  As  met  with  in  the  shops,  it  is 
of  a brownish  or  grayish*  white  colour,  has  lit- 
tle or  no  odour,  and  a bitter,  mucilaginous, 
somewhat  astringent  taste.  The  dry  plant, 
steeped  in  water,  absorbs  more  than  its  own 
weight  of  the  fluid.  When  analysed  by 
Berzelius,  it  yielded  44.6  per  cent,  of  starchy 
matter,  Lichenm,  — 3.0  of  a peculiar  bitter  principle,  termed  Cetrarin, 
and  whose  medical  properties  will  be  considered  elsewhere;  7.3  of 
gum  and  uncrystallisable  sugar;  7 of  extractive  matter;  36.2  of 
starchy  lignin,  besides  colouring  matter,  and  various  salts. 

Cetraria  may  be  deprived  of  its  bitter  principle  by  a double  mace- 
ration in  water,  or  in  water  containing  part  of  an  alkaline  car- 
bonate. If  it  be  then  dried  and  reduced  to  powder,  it  forms  a 
nutritive  aliment,  which  is  made  into  bread  by  the  Icelanders  and 
Laplanders,  or  boiled  with  milk. 

Cetraria  has  been  much  used  in  cases  where  demulcents  in  general 
are  indicated,  and,  therefore,  as  a demulcent  expectorant.  It  is  em- 


Fig.  3?- 


Cetraria  Tslandica. 


CHONDRUS. 


247 


ployed,  also,  in  pulmonary  affections  with  the  same  view  as  arrow- 
root,  sago,  or  tapioca,  as  a bland,  nutritious  article  of  diet,  and  it 
does  not  seem  to  possess  any  advantage  over  those  articles.  It  has 
been  highly  extolled  in  pulmonary  consumption ; but  it  is  now  uni- 
versally considered  to  possess  no  peculiar  properties  either  in  that  or 
any  other  disease. 

The  powder  is  occasionally  — but  very  rarely  — given  in  the  dose 
of  from  ,^ss.  to  Sj ; and  it  is  sometimes  mixed  with  chocolate,  and 
taken  night  and  morning  for  breakfast  and  supper.  The  most  com- 
mon form  of  administration  is  the 

DECOC'TUM  CETRA  Rin,  DECOC  TION  OF  ICELAND  MOSS.  {Cetraria,  |ss  ; 
Aquce^  Oiss.  Boil  to  a pint,  and  strain  forcibly).  The  bitter  prin- 
ciple or  cetrarin  is  contained  in  this  decoction.  It  thus  combines 
demulcent  and  tonic  virtues.  The  bitterness  may,  however,  be  first 
extracted  — as  before  remarked  — by  maceration  in  water,  or  in  a 
weak  alkaline  ley. 

The  quantity  to  be  taken  during  the  day,  as  a demulcent  and 
nutrient,  is  about  a pint  in  divided  doses.  It  is  sometimes  mixed 
with  milk. 

30.  CHONDRUS.— IRISH  MOSS. 

Car'rageen^  Cor'igeen  or  Irish  Moss^  is  Chondrus  crispus,  Lichen 
Car'rigeen^  Fucus  crispus^  Sphcerococ' cus  crispus,  TJlva  crispa,  or 
Chondrus polymor' phus ; Sex.  Syst.  Cryptogamia;  Nat.  Ord.  Algae — 
Algaceae  (Bindley).  It  is  found  in  the  Atlantic  ocean,  on  the  shores 
of  England,  Ireland,  western  France,  Spain  and  Portugal,  and  as  far 
as  the  Tropics,  and  is  also  said  to  be  a native  of  the  United  States. 
For  medicinal  and  dietetic  purposes,  it  is  collected  on  the  coasts  of 
Ireland  (especially  in  Clare),  where  it  is  washed,  bleached  by  ex- 
posure to  the  sun,  and  dried.  In  Ireland,  it  is  used  by  the  poor  as 
an  article  of  diet. 

When  Irish  moss  is  green  it  resembles  Iceland  moss ; but  as  met 
with  in  the  shops,  it  is  dry,  crisp,  and  of  a yellowish  or  dirty  white 
hue,  resembling  laminse  of  horn.  It  is  nearly  inodorous,  and  has  a 
mucilaginous  taste.  When  chewed,  it  feels  like  so  much  cartilage, 
but  by  the  warmth  and  moisture  of  the  mouth  it  soon  loses  its  brittle- 
ness. Its  main  constituent  is  a vegetable  jelly  — which  exists  in  it 
in  the  proportion  of  79.1  per  cent.,  and  which  has  been  considered 
to  consist  of  Pectin^  in  large  proportion  — and  starch,  but  which  Dr. 
Pereira  esteems  a peculiar  principle  and  calls  Carrageenin.  It  con- 
tains likewise,  9.5  per  cent,  of  mucus,  and  traces  of  salts. 

In  order  to  obtain  the  jelly  of  the  moss,  it  is  cut  small,  carefully 
freed  from  impurities,  and  boiled  with  water  or  milk,  if  the  latter 
should  be  desirable,  and  strained.  Von  Grafe  obtained  from  nine 
ounces  of  milk^  boiled  with  half  a drachm  of  the  moss^  five  ounces 
of  jelly ; and  as  much  from  a drachm  and  a half  of  the  moss^  and 
twelve  ounces  of  water.  To  the  jelly  thus  formed,  any  dietetic  or 
therapeutical  agent  may  be  added. 


248 


SPECIAL  EXPECTORANTS. 


Irish  moss  has  been  recommended  under  the  same  circumstances 
as  Iceland  moss ; and  it  would  appear,  that,  like  it,  no  more  service 
can  be  expected  from  it  than  from  substances  that  contain  a similar 
principle.  Accordingly,  few  prescribe  it  with  any  other  view  than 
as  a demulcent  and  nutritious  aliment,  where  such  appears  to  be  in- 
dicated. 

To  remove  any  unpleasant  flavour,  which  the  moss  may  have  ac- 
quired from  impurities,  it  is  advised,  that  before  it  is  boiled,  it  should 
be  macerated  in  water  for  a few  minutes. 

Chondrus  is  in  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States ; Cetraria  in  the  primary ; but  there  is  no  sufficient 
reason  perhaps  to  assign  the  one  a more  important  place  than  the 
other. 


31.  FUCUS  AMYLA'CEUS.— CEYLON  MOSS,  MARINE  MOSS. 

The  attention  of  physicians  was  first  directed  to  this  vegetable  by 

Dr.  O’Shaughnessy,  of  Calcutta. 
Fig.  38.  Like  chondrus,  it  belongs  to  the 


Fucus  vesiculosus. 


a.  Upper  part  of  a frond. 
k.  Section  of  a receptacle. 

c.  Tubercle. 

d.  Filaments  and  sporangia,  of  which  the 
tubercles  are  composed. 

e.  Filaments  which  issue  from  the  pores  on 
the  surface  of  the  frond. — (Pereira.) 


natural  order  Algae,  and  was  first 
introduced  some  years  ago  from 
India  into  England.  As  met  with 
in  the  shops,  it  is  white,  filiform 
and  fibrous,  and  has  the  usual 
odour  of  sea  weeds.  Analysed  by 
Dr.  O’Shaughnessy,  it  was  found 
to  be  composed  of  vegetable  jelly, 
54.50 ; true  starch,  15 ; wax,  a 
trace;  ligneous  fibre,  18;  gum,  4; 
sulphate  of  soda  and  chloride  of 
sodium,  6.50  ; sulphate  and  phos- 
phate of  lime,  1 ; iron,  a trace  ; 
loss  1.  When  boiled  in  water,  a 
liquid  results,  which  gelatinises 
on  cooling. 

The  jelly  is  prepared  like  that 
of  chondrus,  and  it  possesses  simi- 
lar medical  properties.  It  is  largely 
employed  by  the  practitioners  of 
India.  (See  the  Author’s  JVew 
Remedies^  4th  edit.  p.  314.  Philad. 
1843.) 


The  Pharmacopceia  of  the  United  States  contains  in  its  second- 
ary list: 

32.  Vi'oLA,  Vi'olet, — the  herb  of  Vi’ola  peda'ta.  — Sex.  Syst. 
Pentandria  Monogynia  ; Nat.  Ord.  Violacea?, — an  indigenous  vio- 
let, which  flowers  in  May  and  June.  All  the  violets  contain  a prin- 
ciple resembling  emetia,  which  has  been  called  Vi'olinc  or  Via'lia, 


BENZOINUM. 


249 


and  the  existence  of  which  in  small  quantities  — it  has  been  sup- 
posed— may  account  for  the  expectorant  properties  ascribed  to  the 
plant.  The  author  has  never  known  it  used. 

III.  JYauseant  and  Emetic  Expectorants. 

Of  the  mode  in  which  naiiseants  and  emetics  probably  act  as  ex- 
pectorants, a brief  notice  has  been  taken  already  (p.  218).  It  is 
evident,  that  all  agents  which  are  capable  of  inducing  nausea,  fol- 
lowed or  not  by  emesis,  may  be  employed  as  expectorants ; and  it 
is  not  improbable,  that  if  they  be  given  short  of  inducing  nausea, 
some  action  of  sedation  maybe  exerted  by  them,  and  that,  therefore, 
they  maybe  adapted  as  sedative  expectorants  for  cases  of  pulmonary 
disease  in  which  the  organic  actions  are  over  excited.  This  at  least 
may  be  the  case  with  the  Tartrate  of  Antimony  and  Potassa, 
Ipecacuanha,  Lobelia,  &c.  ; but  on  the  other  hand,  if  certain  agents, 
as  Squill,  be  given  in  a small  dose,  they  act  as  excitants,  and  hence 
it  is  important,  that  they  should  be  pushed  to  an  extent  but  little,  if 
at  all,  short  of  inducing  nausea. 

Of  the  nausearits,  ipecacuanha  is  most  frequently  perhaps  pre- 
scribed as  an  expectorant,  singly,  or  — what  is  far  more  common  — 
in  combination  with  opium ; and  not  unfrequently  it  is  added  to  de- 
mulcent mixtures  to  aid  their  expectorant  agency.  The  following 
form,  introduced  into  the  last  edition  of  the  Pharmacopoeia  of  the 
United  States,  (1842,)  is  a combination  of  this  kind. 

Trochis'ci  Ipecacuan'h^,  Troches  of  Ipecacuan'ha.  {Ipecac,  in 
pulv.  ^ss;  Sacchar.  in  pulv.  §xiv ; marant.  pulv.  §iv  ; mucilag.  tra- 
gacanth.  q.  s.  Each  troche  to  weigh  ten  grains.)  These  lozenges 
are  well  adapted  for  inflammatory  affections  of  the  lining  membrane 
of  the  bronchial  tubes. 

IV.  — Topical  Expectorants. — Inhalations. 

a.  Kxcitant  Inhalations, 

33.  BENZO'INUM.— BEN'ZOIN. 

Of  the  virtues  of  this  balsam  as  an  excitant  expectorant,  mention 
has  already  been  made  (p.  229).  At  times,  it  is  employed  in  the 
way  of  vapour ; but  caution  is  demanded  in  inhaling  it,  as  it  excites 
coughing,  unless  largely  diluted  with  atmospheric  air.  It  ought  to 
be  inhaled  along  with  the  vapour  of  water,  by  breaking  benzoin  into 
pieces,  putting  them  into  a jar,  and  pouring  boiling  water  over  them. 
In  this  manner,  the  acid  rises  with  the  vapour  and  is  taken  into  the 
lungs.  Its  action  is  excitant  to  the  nerves  of  the  lining  membrane 
of  the  air  passages,  and  through  them  to  the  respiratory  nerves  in 
general ; and  it  has  seemed  to  have  afforded  decided  relief  in  asthma 
depending  on  some  morbid  condition  approaching  to  paralysis  of  the 
pneumogastric  nerves.  (A.  T.  Thomson.)  It  is  said  to  have  proved 


250 


SPECIAL  EXPECTORANTS. 


beneficial  even  in  phthisis  after  the  existence  of  tubercles  had  been 
clearly  ascertained;  but  it  can  only  have  acted  as  a palliative,  and 
probably  in  the  manner  already  described,  through  its  excitant  im- 
pression on  the  respiratory  nerves : expectoration  being  thus  facili- 
tated, and  dyspnoea  relieved.  MM.  Trousseau  and  Pidoux  strongly 
recommend  the  mode  of  employing  the  balsams  in  chronic  laryngitis, 
by  throwing  some  of  the  benzoin  or  the  balsam  of  Tolu  on  hot  coals. 
They  advise  this  plan  in  preference  to  inhalations  of  boiling  water 
containing  the  balsam,  inasmuch  as  the  patient  can  remain  without 
fatigue  for  whole  days  in  a balsamic  atmosphere. 

They  affirm  that  chronic  catarrh  has  been  removed  in  this  way, 
which  had  resisted  the  internal  use  of  the  balsams.  None  of  the 
balsams  are  much  used  in  this  manner  on  this  side  the  Atlantic,  or 
in  Great  Britain. 


34.  ACE'TUM.— VJN'EGAR. 

Vinegar  is  the  result  of  what  is  termed  the  ace' tons  fermenta'tiorij 
and  is  impure  dilute  acetic  acid.  All  liquids,  that  are  capable  of 
the  vinous  fermentation,  are  capable  of  the  acetous,  and  can,  there- 
fore, affiord  vinegar:  hence  it  is  made  from  various  substances;  — 
in  France  and  Spain  from  the  lighter  wines;  in  Great  Britain  from 
malt  and  malt  liquors,  and  in  the  United  States  from  cider.  For  the 
use  of  the  white  lead  manufacturer,  it  is  said  to  have  been  exten- 
sively prepared,  of  late  years,  from  potatoes.  (Wood  & Bache.) 

The  difference  in  the  quality  of  commercial  vinegars  is  very  great, 
some  being  four  times  as  strong  as  others.  Certain  vinegars  are, 
indeed,  so  weak,  as  not  to  be  fit  for  the  preparation  of  the  Ace'tum 
Desttlla'tum,  and  others  are  so  full  of  impurities,  that  they  can 
scarcely  be  used  for  making  certain  officinal  preparations.  It  was 
not  without  reason,  therefore,  that  the  framers  of  the  Pharmacopoeia 
of  the  United  States  (1842)  gave  the  following  rules  for  determining 
its  strength  and  purity.  ‘‘  One  fluidounce  is  saturated  by  about 
thirty-five  grains  of  crystallised  bicarbonate  of  potassa.  It  affords  no 
precipitate  with  solution  of  chloride  of  barium,  and  is  not  coloured 
by  sulpho-hydric  acid.”  The  solution  of  the  chloride  of  barium  de- 
tects sulphuric  acid,  if  any  be  present ; and  the  sulpho-hydric  acid 
the  presence  of  metallic  matter. 

The  French, vinegars  — as  a general  rule  — are  better  for  all  pur- 
poses than  the  British.  The  best  qualities  imported  into  Great  Bri- 
tain are  from  Bordeaux,  and  are  known  under  the  name  of  Cham- 
pagne Vinegar,  although  made  from  other  wines.  Two  sorts  of 
wine  vinegar  are  met  with  in  commerce,  made  from  wines  of  a cor- 
responding colour:  that  from  the  red  wines  may  be  decolourised 
by  passing  it  repeatedly  through  animal  charcoal. 

In  this  country  — as  before  remarked  — vinegar  is  generally  made 
from  cider  that  has  become  sour.  This  is  put  into  a barrel  in  a warm 
place,  along  with  some  good  vinegar,  or  mother  of  vinegar,  which 
acts  as  a ferment.  The  vinegar  is  ready  in  the  course  of  a few 
weeks. 


CIILORINUM. 


251 


The  constituents  of  vinegar  are  essentially  acetic  acid,  and  water, 
in  addition  to  which  it  contains  colouring  matter,  gum,  starch,  sugar, 
&c.  &c.,  according  to  the  particular  substance  from  which  it  has 
been  derived. 

As  a topical  expectorant,  vinegar  is  sometimes  used,  being  put 
into  the  ordinary  inhaler  hot,  and  in  a dilute  state.  In  this  manner 
it  acts  as  an  excitant  to  the  bronchial  nerves,  and  is  of  service  in  the 
same  cases  as  benzoic  acid  and  other  balsams,  by  facilitating  the 
expectoration  of  mucus,  and  other  secretions  that  may  have  col- 
lected in  the  air  passages.  It  has  been  of  advantage  in  asthma, 
and  various  spasmodic  affections  of  the  respiratory  system.  It  has 
been  advised  by  Dr.  A.  T.  Thomson  that  distilled  vinegar  should  be 
employed  by  preference,  as  common  vinegar  is  apt  to  contain  sul- 
phuric acid. 

35.  ACE'TUM  DESTILL A'TUM.  — DISTIL'LED  VIN'EGAR. 

This  is  made  by  distilling,  from  eight  pints  oi  vinegar^  seven,  and 
preserving  these  for  use.  One  fluid  ounce  of  this  should  be  capa- 
ble of  being  saturated  by  about  thirty-five  grains  of  crystallised 
bicarbonate  of  potassa. 

Distilled  vinegar  is  colourless,  or  of  a yellowish  hue,  and  contains, 
besides  acetic  acid  and  water,  a little  alcohol,  acetic  ether,  and  a 
substance  of  a mucilaginous  character,  which,  when  the  acid  is 
saturated  by  an  alkali,  causes  the  solution  to  be  of  a reddish  or 
brownish  colour.  When  properly  prepared,  it  has  no  empyreumatic 
or  other  disagreeable  taint. 

A diluted  acetic  acid^  which  has  the  same  strength  as  distilled 
vinegar,  is  made  by  taking  the  acetic  acid — AC'IDUM  ACE'TICUM  of  the 
Pharmacopoeia  of  the  United  States,  (1842,) — which  is  prepared  by 
the  action  of  the  sulphuric  acid  on  acetate  of  soda,  and  diluting  it 
with  ten  parts  of  distilled  water.  This  is  the  AC'IDUM  ACE'TICUM 
DILU  TUM  or  diluted  acetic  acid.  Either  this  preparation  or  the  dis- 
tilled vinegar  may  be  employed  in  the  way  of  inhalation. 

36.  TOLUTA'JNUM.  — TOLU. 

Balsam  of  Tolu  — whose  general  properties  have  been  already 
described  (p.  226)  — may  bemused  as  a balsamic  fumigation  in  the 
same  cases,  and  in  the  same  manner  as  Benzoin.  The  air  of  the 
patient’s  chamber  may  be  impregnated  with  the  vapour,  by  placing 
a little  of  it  upon  live  coals,  and  allowing  the  vapour  to  be  dif- 
fused in  the  room  ; or  a drachm  or  two  may  be  put  in  boiling  water, 
and  the  vapour  be  drawn  into  the  lungs  by  means  of  an  ordinary 
inhaler. 

37.  CHLO'RINUM.  — CHLORINE. 

Undiluted  chlorine  gas  is  irrespirable,  occasioning  spasmodic 
closure  of  the  glottis,  and  immediate  asphyxia.  When  largely  di- 
luted, it  is  a powerful  irritant  to  the  mucous  membrane  of  the  respira- 


252 


SPECIAL  EXPECTORANTS. 


tory  organs,  and  may  develope  inflammation  in  it  or  in  the  tissue 
of  the  lungs,  unless  great  caution  is  taken  in  administering  it.  When 
largely  diluted,  it  may  induce  a salutary  excitant  agency,  and  has 
hence  been  employed  as  a topical  expectorant  of  the  excitant  class. 
It  has  been,  indeed,  affirmed  by  Dr.  A.  T.  Thomson,  that  it  is  the 
best  topical  expectorant  and  the  most  salutary  excitant  to  the  mu- 
cous membrane  of  the  lungs  that  has  yet  been  inhaled.” 

Chlorine  has  been  administered  as  a remedy  in  phthisis  ; and 
many  testimonials  have  been  brought  forward  in  its  favour.  It  has 
been  observed  in  manufactories  in  which  it  is  employed,  that  phthisi- 
cal patients  have  experienced  decided  benefit,  but  experiments 
made  with  it  on  an  extensive  scale  in  large  public  institutions  have 
not  confirmed  these  favourable  reports ; and  some  writers  of  dis- 
tinction have  affirmed,  that  it  has  been  prejudicial.  In  all  cases  it 
has  to  be  employed  carefully,  and  experimentally  ; but  no  marked 
benefit  can  be  expected  from  it  in  phthisis.  If  can  only  be  adapted 
for  cases  of  disease,  in  which  the  pathological  condition  of  the  bron- 
chial mucous  membrane,  or  neighbouring  parts,  requires  the  exhibi- 
tion of  an  excitant.  In  this  way,  it  may  be  occasionally  serviceable 
in  chronic  bronchitis. 

It  may  be  obtained  by  putting  f.  5]  or  f.  ^ij  of  a saturated  solu- 
tion of  the  gas  in  water — the  Aqua  Chlorini,  (JVm  Remedies^ 
4th  edit.  p.  153,  Philad.  1843,)^ — into  an  inhaler  containing 
about  f.  ^ij  of  hot  water,  and  placing  this  in  a basin  of  hot  water,  or 
over  a lamp,  in  order  to  drive  oflf  the  chlorine.  The  quantity,  thus 

disengaged,  may  be  inhaled  every 
six  hours.  Recently,  it  has  been 
proposed  to  diffuse  it,  by  means 
of  an  appropriate  apparatus,  in  the 
atmosphere  of  the  sick  chamber. 
For  this  purpose,  any  of  the  acids, 
as  the  chlorohydric,  maybe  drop- 
ped on  a mixture  of  chlorinated 
lime,  so  that  the  chlorine  may 
be  disengaged  slowly.  An  appa- 
ratus has  been  suggested,  of  late 
years,  that  answers  this  purpose 
well.  It  consists  of  a light  open 
wire  frame,  about  18  inches  high  ; 
at  the  bottom  of  which  is  a spirit 
lamp  A.  At  the  proper  height 
above  it  is  an  evaporating  por- 
celain dish,  about  six  inches  in 
diameter,  B ; and  above  this  is  a 
glass  globe  C,  with  its  neck 
downwards.  In  the  neck  of  the 
globe  is  a cork  D,  bored,  and 
through  the  opening  is  drawn,  moderately  tight,  a short  plug  of 


Fig.  39. 


lODINUM. 


cotton  wick,  such  as  is  used  in  a spirit  lamp.  In  the  glass  globe 
at  E,  opposite  the  neck,  is  drilled  a pin-hole,  to  allow  air  to  pass  in, 
according  as  the  fluid  within  drops  out  through  the  neck.  To  use  it, 
the  porcelain  dish  is  filled  with  hot  water,  the  spirit  lamp  is  light- 
ed, and  as  soon  as  the  water  in  the  dish  has  begun  to  boil,  the 
glass  globe  containing  the  chloride  — if  this  be  the  substance 
used  — is  placed  as  exhibited  in  the  marginal  figure.  The  rate  at 
which  the  fluid  in  the  globe  shall  percolate  the  cotton  wick,  and 
drop  into  the  hot  water  beneath,  is  easily  regulated.  Should  it  not 
drop  with  sufficient  rapidity,  one  or  two  of  the  threads  of  the  cotton 
may  be  removed  ; if  too  rapidly,  the  cork  maybe  pressed  in  tightly, 
or  one  or  more  additional  threads  of  wick  be  introduced. 

Eight  ounces  of  a saturated  solution  of  chlorinated  lime  may  be 
poured  into  the  glass  globe  ; and  into  the  water  of  the  porcelain  dish 
two  ounces  of  dilute  sulphuric  acid  of  the  pharmacopoeias.  As  the 
solution  of  the  chloride  drops,  the  acid  seizes  on  the  lime,  and  chlo- 
rine is  evolved  in  connexion  with  aqueous  vapour. 

In  this  manner,  a sufficient  supply  of  aqueous  vapour  is  given  off 
to  prevent  any  irritation  of  the  lining  membrane  of  the  air  passages, 
whilst  the  invalid  experiences  neither  trouble  nor  fatigue. 

38.  lOD'INUM.  — I'ODINE. 

The  inhalation  of  iodine  has  been  recommended  as  an  excitant 
topical  expectorant  in  the  same  diseases  as  that  of  chlorine.  In 
phthisical  affections  it  has  been  strongly  advised.  Sir  Charles  Scuda- 
more found  the  addition  of  a little  tincture  of  conium  beneficial  in 
subduing  the  irritating  qualities  of  the  gas.  His  first  formula  was 
the  following  solution  of  ioduretted  iodide  of  potassium  : — lodin. 
gr.  viij  ; Potass.  lodid.  gr.  iij  ; Alcohol,  f.  §ss;  Aquce  destillat.  f.  ^vss. 
M.  Of  this  solution,  from  f.  to  f.  ^vj,and  from  twenty  to  thirty- 
five  minims  of  a saturated  tincture  of  conium  were  used  in  each  in- 
halation.) At  the  temperature  of  90°,  the  volatile  properties  of 
iodine  are  given  off  very  sensibly,  but  the  conium  requires  more 
heat,  and  that  of  120°  is  not  too  much  for  the  iodine.  Sir  Charles, 
now  advises  the  following  : — (lodin. ; Potass.  lodid.  aa  .^vj  ; Aquce 
destillat.  f.  ^v  & ^vj  ; Alcohol^  f.  ^ij.  M.)  He  now  prefers  to  add 
the  conium  at  the  time  of  mixing  the  iodine  solution  with  the  water, 
and  recommends  that  it  should  be  a saturated  tincture  of  the  genuine 
dried  leaves.  In  the  commencement  of  the  treatment,  he  advises 
very  small  proportions  of  the  iodine  mixture  ; — for  example,  from 
f.  Jss  to  f.  5j,  for  an  inhalation  of  eight  or  ten  minutes’  duration, 
and  this  to  be  repeated  two  or  three  times  a day:  of  the  tincture  he 
directs  f.  5ss  — to  be  increased  if  the  cough  be  very  troublesome. 
He  soon  augments  the  quantity  of  the  Iodine  mixture  from  f.  to 
f.  ^iv,  but  the  feelings  of  the  patient  will  be  a great  guide  as  to  the 
proper  strength  of  the  inhaling  mixture  in  any  particular  case. 

The  author  has  often  used  the  iodine  inhalation  in  phthisis,  but 
his  experience  has  not  been  favourable  to  it ; and  the  same  view 
VOL.  I. — 22 


254 


SPECIAL  expectorants. 


has  been  entertained  by  others.  It  would  seem  to  be  better  adapted 
lor  cases  of  chronic  bronchitis. 

The  inhalation  may  be  practised  in  the  method  recommended  for 
chlorine.  At  times,  troublesome  laryngeal  irritation  has  been  caused 
by  it.  Used,  however,  with  the  conium,  or  with  aqueous  vapour  in 
the  apparatus  recommended  by  Dr.  Corrigan,  (p.  252,)  this  disa- 
greeable result  may  be  prevented,  and,  in  this  way,  it  has  been 
found  to  diminish  most  remarkably  the  purulent  expectoration  of 
phthisis.  It  improved  the  tone  of  the  digestive  organs  ; alleviated 
the  cough,  and  acted,  therefore,  as  a valuable  palliative.  Dr.  Cor- 
rigan has  had  his  apparatus  at  work  from  eight  to  twelve  hours  in 
the  twenty-four,  and  his  method  of  managing  it  is  as  follows:  — At 
night,  when  the  patient  is  settling  to  sleep,  the  apparatus  is  sus- 
pended from  the  roof  of  the  bed,  and,  when  once  arranged,  it  con- 
tinues its  work  for  four  or  five  hours,  whilst  the  patient,  asleep,  is 
inhaling  the  medicated  air.  In  the  morning,  for  three  or  four  hours 
before  the  patient  rises,  it  may  be  again  at  work,  and,  if  necessary, 
at  mid-day,  whilst  he  reclines  on  the  bed,  with  the  curtains  drawn 
round  three  of  the  sides.  The  rate  of  evaporation,  which  has  been 
generally  found  to  give  a sufficiently  strong  impregnation  to  the  air, 
is  when  the  tincture  of  iodine  drops  from  the  cotton  wick  in  the 
globe  at  the  rate  of  six  or  eight  drops  per  minute.  At  this  rate, 
about  six  drachms  of  the  tincture  will  be  evaporated  in  an  hour. 

39.  VAPOUR  OF  BOILING  TAR,  BURNING  WOOL,  CRE'ASOTE,  &c. 

These  vapours  have  been  inhaled  in  cases  of  phthisis,  and  in 
chronic  laryngitic  and  bronchitic  affections.  In  the  first  disease, 
no  great  benefit  can  be  expected  from  them.  In  the  latter,  they 
may  act  as  excitants  to  the  mucous  membrane  of  the  air-passages, 
and,  in  certain  cases,  be  beneficial. 

Tar  vapour  was  strongly  recommended  in  phthisis  by  Sir  Alex- 
ander Crichton ; but  although  it  has  seemed  to  act  occasionally  as 
a palliative,  it  not  unfrequently  causes  a temporary  increase  of 
cough  and  irritation.  The  tar  employed  should  be  that  used  in 
the  cordage  of  ships,  to  every  pound  of  which  half  an  ounce  of 
carbonate  of  potassa  is  added,  in  order  to  neutralise  the  pyrolig- 
neous acid,  which  is  generally  found  mixed  with  the  tar,  and  the 
presence  of  which  may  excite  coughing.  The  tar,  thus  prepared, 
is  placed  over  a lamp  in  a suitable  vessel,  and  kept  slowly  boil- 
ing in  the  chamber  night  and  day.  The  vessel  ought,  however, 
to  be  cleaned  -every  twenty-four  hours,  otherwise  the  residuum  may 
be  burned  and  decomposed,  which  occasions  irritation. 

It  is  a prevalent  idea,  that  the  terebinthinate  impregnation  of 
the  air  which  exists  in  pine  regions  is  beneficial  to  the  consump- 
tive, and,  accordingly,  patients  are  frequently  sent  to  spend  some 
time  in  such  localities. 

The  Vapour  of  Resin  has  occasionally  been  used  under  similar 


TABACUM. 


255 


circumstances,  as  well  as  the  fumes  arising  from  burning  wool  that 
has  not  been  dressed.  All  these  vapours  are  apt  to  increase  the 
cough  at  first,  but  both  it  and  the  expectoration  would  seem  to  have 
been  ultimately  diminished.  They  must  obviously,  however,  be  un- 
certain agents  in  all  cases,  and  not  easily  regulated,  and  they  cannot, 
of  course,  produce  any  material  change  in  the  tuberculous  condition. 

Cre'asote,  like  tar  vapour,  has  been  occasionally  inhaled  in  the 
same  pulmonary  affections:  — five,  ten  or  fifteen  drops,  according 
to  the  degree  of  tolerance  of  the  lungs,  being  dropped  into  hot 
water,  in  an  appropriate  vessel,  and  the  vapour  being  inhaled 
through  the  tube  of  an  inverted  funnel,  or  by  means  of  any  of  the 
inhalers  in  use  ; but  the  remarks  on  the  value  of  tar  vapour  in 
phthisis,  and  other  pulmonary  affections,  apply  equally  to  creasote. 

b.  Sedative  Inhalations, 

40.  STRAMO'NIUM. 

Every  part  of  Datu'ra  Stramo'nium,  — whose  general  properties 
are  described  under  Narcotics,  — has  been  smoked  for  the  relief 
of  asthma, — and  whilst  one  part  of  the  plant  has,  in  this  form, 
afforded  relief  in  one  case,  another  has  been  successful  in  a second. 
A case  of  this  kind  has  been  already  referred  to,  (p.  222.)  In  this 
form  of  administration,  a poisonous  principle  is  probably  developed  ; 
for,  according  to  Dr.  Christison,  Mr.  Morries-Stirling  obtained  by 
destructive  distillation  a poisonous  oil,  composed  of  an  inert  true  oil 
in  union  with  an  active  principle,  probably  a modification  of  Da- 
turia. 

The  author  has  often  seen  the  inhalation  of  the  vapour  of  stra- 
monium highly  beneficial.  Its  modus  operandi  is  probably  through 
the  sedative  influence  exerted  by  the  narcotic  principle  upon  the 
ramifications  of  the  pneumogastric  nerves  distributed  to  the  bron- 
chial tubes,  — the  sedation  being  thence  extended  to  the  rest  of 
the  nervous  system,  so  that  the  spasmodic  affection  is  subdued. 

Almost  all  therapeutical  writers  affirm,  that  the  smoking  of  stra- 
monium is  attended  with  danger  "where  there  is  a tendency  to  ence- 
phalic disease,  and  especially  to  apoplexy,  and  where  a plethoric 
state  of  the  system  exists  ; but  the  author  has  never  witnessed  bad 
effects  from  it.  Of  course,  caution  is  needed  in  the  use  of  this 
powerful  narcotic  as  in  that  of  tobacco,  for  similar  acro-narcotic 
symptoms  may  be  produced  by  both. 

41.  TAB'ACUM.  — TOBAC/CO. 

When  tobacco,  — whose  general  properties  have  oeen  described 
elsewhere,  (p.  126,)  — is  smoked,  not  only  does  the  nicotia  pass 
into  the  lungs,  but  the  empyreumatic  oil  of  tobacco,  which  is  an 
active  poison,  as  formed  in  the  pipe  of  the  smoker,  and  appears  to 
be  nicotia  attached  to  a true  volatile  oil. 

The  effect  of  tobacco,  when  inhaled,  is  familiar  to  most  persons. 


256 


ERRHINES. 


for  there  are  probably  few  males  who  have  not  tested  it.  It  is  a 
powerful  sedative,  making  its  impression  on  the  nerves  of  the  bron- 
chial tubes  with  which  it  comes  in  contact,  whence  the  impression 
irradiates  to  every  part  of  the  system.  In  this  manner  it  is  anti- 
spasmodic.  It  is  in  spasmodic  asthma  that  its  good  effects  have 
been  most  witnessed,  but  it  does  not  agree  with  all,  and  requires 
caution,  especially  in  those  who  have  not  been  accustomed  to  its 
use.  Smoking  a cigar  is  said  by  Dr.  Chapman,  of  Philadelphia,  to 
have  been  used  in  a case  of  croup  with  great  success. 


SECTION  III. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  FOLLICULAR  OR 
GLANDULAR  ORGANS. 


I.  ER/RHINES. 

SiNON.  Ptarmica^  Sternutatoria,  Jlpophlegmatisantia  per  nares. 

Definition  of  errhines  — Sternutatories  — Modus  operandi — Dangers  of  sneezing  — 

Special  errhines. 

This  class  of  medicinal  agents  is  much  less  used  now  than  for- 
merly. There  are,  indeed,  but  few  cases  in  which  their  employment 
can  be  suggested.  At  one  time  errhines  were  separated  from  ster- 
nutatories j — the  former  comprising  agents,  that  excite  an  increased 
discharge  from  the  Schneiderian  membrane  ; the  latter  those  that 
provoke  sneezing ; but  the  class  of  errhines  is  now  made  to  include 
both  under  the  definition  — “ Agents  that  occasion  an  increased  dis- 
charge from  the  Schneiderian  membrane,  and  sneezing.” 

When  an  irritating  substance  is  placed  in  contact  with  the  Schnei- 
derian membrane,  it  excites  a sensation,  through  the  fifth  pair  of 
nerves,  or  nerves  of  general  sensibility,  distributed  to  the  nose,  and 
by  a reflex  action  the  appropriate  muscles  concerned  in  sneezing 
are  thrown  into  contraction,  in  order  that  the  source  of  irritation 
may  be  ejected  by  the  anterior  nares.  At  the  same  time,  if  the 
errhine  remains,  for  any  time,  in  contact  with  the  membrane,  a 
centre  of  fluxion  is  established  ; the  follicles  augment  their  secretion  ; 
and,  if  the  substance  be  still  more  irritating,  true  inflammation  is 
excited.  This  effect,  of  course,  takes  place  more  immediately  in 
the  part  of  the  mucous  membrane  with  which  the  errhine  comes 
in  contact ; but  the  excitation  is  extended  more  or  less  to  the  mucous 
membranes,  which  may  be  regarded  as  continuous  with  that  which 
lines  the  nasal  passages  — for  example,  those  that  line  the  sinuses 
and  ductus  ad  nasum.  In  this  way  it  can  be  understood,  that  the 
operation  of  an  errhine  may  augment  the  secretion  of  tears,  and 
occasion  more  or  less  suffusion  of  the  eyes ; and,  conversely,  that 


ERRHINES. 


257 


I 

an  inflamed  state  of  the  conjunctiva  may  give  rise  to  increased  dis- 
charge of  mucus  from  the  lining  membrane  of  the  nasal  fossae 
and  sinuses,  and  to  sternutation.  A sense  of  irritation  in  the  nose, 
inciting  to  the  operation  of  clearing  the  nasal  fossaej  is,  indeed,  a 
common  accompaniment  of  ophthalmia. 

From  what  has  been  observed,  it  is  clear,  that  if  an  errhine  be 
too  strong,  instead  of  increasing  the  discharge  from  the  Schnei- 
derian membrane,  it  may  arrest  even  the  healthy  secretion.  This 
is,  indeed,  one  of  the  well  known  first  effects  of  inflammation  of 
any  mucous  membrane,  and  it  is  not  until  the  inflammation  has 
persisted  for  some  time,  that  the  secretions  are  materially  aug- 
mented. 

To  prevent  the  induction  of  inflammatory  irritation,  the  more 
powerful  errhines  are  always  weakened  by  the  addition  of  some 
inert  powder. 

Therapeutical  Applications  of  Errhines. 

A knowledge  of  the  modus  operandi  of  this  class  of  medicinal 
agents  at  once  suggests  the  cases,  in  which  they  might  rationally  be 
had  recourse  to.  They  occasion  a centre  of  irritation  in  the  part  of 
the  membrane  with  which  they  are  made  to  come  in  contact ; a 
derivation  of  nervous  and  vascular  action  from  other  parts  is  thus 
effected  ; an  increased  discharge  takes  place  from  the  exhalants  and 
follicles  of  the  nasal  mucous  membrane  — although  this  has  proba- 
bly but  little  curative  agency  — and  if  they  excite  sternutation,  a 
strong  revulsive  impression  is  made. 

Possessed  of  these  properties,  errhines  have  been  used  in  head 
affections  in  general ; and  especially  in  diseases  of  the  eyes  and  ears  ; 
but  still,  their  remedial  powers  are  very  limited,  and  if  much  sneez- 
ing be  produced,  they  may  cause  more  mischief  than  benefit.  It 
is  on  this  account,  that  they  are  rarely  administered  except  in  popu- 
lar practice. 

Physiologically,  sneezing  is  set  up  to  clear  the  nostrils  from  any 
source  of  irritation.  It  is  hence  often  excited  in  the  way  of  an  ex- 
ternal sensation  — that  is,  by  some  substance  impinging  on  the 
Schneiderian  membrane.  But  it  often  occurs,  also,  as  an  internal 
sensation,  — that  is,  produced  by  some  organic  change  in  the  mu- 
cous membrane  itself.  Hence,  it  is  a symptom  of  inflammation  of 
the  Schneiderian  membrane,  as  in  common  cold,  and  in  the  catarrh 
that  attends  measles. 

Dr.  A.  T.  Thomson  refers  to  a case  of  benefit  from  sternutation, 
in  which  this  agency  appears  to  have  been  prescribed  empirically. 
The  result  may  be  borne  in  mind  with  advantage,  as  it  may  attract 
attention  to  a cause  of  cephalalgia,  that  might  otherwise  be  unsus- 
pected. A lady  was  afflicted  with  violent  headache,  accompanied 
by  the  sensation  well  known  by  the  term  stuffing  in  the  head. 
Many  remedies  were  proposed,  and  tried,  but  ineflfectually.  A 
physician  was  called  in,  who  prescribed  snuff  as  a sternutatory.  It 
22*^ 


258 


SPECIAL  ERRHINES. 


produced  violent  sneezing,  and  the  ejection,  from  one  of  the  nos- 
trils, of  a plug  of  hardened  mucus,  nearly  an  inch  long ; after  which 
she  experienced  immediate  relief,  and,  in  24  hours,  was  perfectly 
recovered. 

From  the  succussion  produced  during  sneezing,  and  the  compres- 
sion of  the  abdominal  viscera,  it  has  been  advised  in  popular  prac- 
tice, when  torpor  of  the  uterus  exists  after  the  extrusion  of  the 
foetus,  with  the  view  of  exciting  that  viscus  to  contraction  for  the  de- 
livery of  the  secundines;  and,  at  times,  it  is  successful;  but  an 
acquaintance  with  the  physiology  of  sneezing  will  equally  show,  that 
it  may  occasionally  be  productive  of  mischief,  by  giving  rise  to  in- 
creased flow  of  blood  to  the  head  by  the  arteries,  and  to  impeded 
return  by  the  veins,  and  thus  produce  apoplexy,  epistaxis  and  other 
head  affections.  The  succussion,  too,  accompanying  it,  is  evidently 
improper  in  pregnancy,  and  d fortiori^  wliere  there  is  tendency  to 
abortion ; or,  where  hernia  or  aneurismal  diseases  exist.  Conradi 
esteems  errhines  to  be  contra-indicated  when  any  inflammatory  con- 
dition is  present;  but  this  caution  is  unnecessary, as  it  could  scarcely 
happen,  that  they  would  be  had  recourse  to,  at  least  before  remedies 
had  been  employed,  which  were  considered  proper  for  the  removal 
of  such  condition. 

It  is  probably  owing  to  the  apparent  violence  done  to  the  system, 
that  the  custom  has  so  long  existed,  in  certain  countries  more  espe- 
cially, of  oflering  a benediction  to  any  one  who  sneezes.  Amongst 
the  Teutonic  nations,  some  form  of  salutation  is  always  bestowed  on 
such  occasions.  Even  a professor,  whilst  addressing  his  hearers,  is 
compelled  to  how  to  the  force  of  custom  when  any  of  the  class  exe- 
cute this  physiological  act. 

It  might  be  agitated  here,  whether  the  habitual  use  of  errhines  — 
as  of  snuff — be  prejudicial;  but  this  is  a question,  which  belongs 
more  to  hygiene  than  to  therapeutics,  and  has  accordingly  been  in- 
vestigated in  another  place.  (See  the  Author’s  Human  Healthy  p. 
334,  Philad.  1844.) 


SPECIAL  ERRHINES. 

1.  VERA'TRUM  ALBUM.  — WHITE  HEL'LEBORE. 

The  powdered  rhizoma  of  White  Hel'lebore  — whose  characters 
are  described  elsewhere  — is  possessed  of  very  acrid  properties  when 
placed  in  contact  with  a mucous  surface,  and  acts  as  a powerful 
errhine  ; hence  the  common  name  of  the  root  — JYiesswurzel  or 
“ sneezing-root,”  in  Germany,  and  .of  the  powder — sneezing  pow- 
der^ in  Great  Britain.  These  properties  are  dependent  upon  its  ac- 
tive principle,  veratria. 

The  action  of  powdered  veratrum  is  so  violent,  that  it  requires  to 


ASARUM  EUROPiEUM. 


259 


be  diminished  by  admixture  with  some  mild  powder,  as  starch, 
wheaten  flour,  or  liquorice,  — at  least  three  or  four  parts  of  these 
powders  being  required  to  one  of  white  hellebore  powder.  Three 
grains,  united  with  nine  grains  of  starch,  snuffed  up  the  nostrils  for 
three  evenings  in  succession,  occasion  a copious  watery  discharge 
from  the  nostrils,  (A.  T.  Thomson.)  In  certain  chronic  encephalic 
affections,  and  in  amaurosis,  it  has  been  used  with  this  view,  but  it 
is  not  often  prescribed. 

2.  VERA'TRIA. 

Veratria,  — the  active  principle  of  veratrum  alburn^  — is  a pow- 
erful errhine,  the  smallest  appreciable  quantity,  applied  to  the 
Schneiderian  membrane,  exciting  the  most  violent  and  repeated  ster- 
nutation. A very  minute  quantity  of  the  acetate  of  veratria,  placed 
in  the  nostrils  of  a dog  by  M.  Magendie,  instantly  caused  violent 
sneezing,  which  continued  for  a long  time. 

It  has  been  remarked,  that  we  possess  the  means  of  making  a 
certain  errhine,  always  of  the  same  strength,  by  combining  veratria 
with  a portion  of  starch  sufficient  to  cover  its  acrimony,  yet  it  is 
proper  to  remark,  that  it  is  an  article  which  is  frequently  adulterated ; 
and  it  is  in  this  way,  that  many  account  for  the  discordance  amongst 
observers  as  to  its  virtues.  It  is,  moreover,  so  violent  at  times  in  its 
operation,  and  if  the  Schneiderian  membrane  be  abraded,  so  much 
inconvenience  may  result  from  its  absorption,  that  if  employed  at 
all  as  an  errhine,  it  ought  to  be  sik  with  the  greatest  caution. 

3.  HYDRAR'GYRI  sulphas  flavus.  — yellow  sulphate  of 

MER'CURY. 

The  yellow  sulphate  of  mercury,  described  under  Emetics,  (p' 
130,)  possesses  strong  errhine  powers,  and  has  the  advantage  over 
some  others  of  always  possessing  the  same  degree  of  strength.  It 
is  so  violent,  however,  in  its  operation,  that  it  requires  to  be  mixed 
with  five  or  six  parts  of  some  farinaceous  powder,  as  starch.  A 
quantity  of  this  compound  powder,  which  contains  one  grain  of  the 
yellow  sulphate,  usually  produces  a discharge  from  the  Schneide- 
rian membrane,  which  may  continue  for  several  days.  It  is  said  to 
have  been  found  very  useful  in  ophthalmic  affections,  and  as  it  pos- 
sesses no  narcotic  properties,  “ there  can  be  no  doubt,”  says  a recent 
writer.  Dr.  A.  T.  Thomson,  “that  it  is  superior  to  every  other 
errhine  in  affections  of  the  head.” 

4.  AS'ARUM  EUROPE  UM.—  ASARABAC'CA. 

Asarum  of  the  British  Pharmacopoeias  is  not  identical  with 
asarum  of  the  Pharmacopoeia  of  the  United  States,  the  latter 
being  an  excitant  tonic,  and,  therefore,  not  falling  under  considera- 
tion here.  The  European  as'arum  or  common  asarabac'ca ; Sex. 
Syst.  Dodecandria  Monogynia ; Nat.  Ord.  Aristolochiaceae,  is  a 
small  herbaceous  plant,  growing  in  moist  hilly  woods  in  England, 


260 


SPECIAL  ERRHINES. 


as  well  as  in  many  parts  of  the  European  continent.  The  leaves  are 
officinal  in  the  British  Pharmacopoeias.  They  are  almost  inodorous, 
but  have  an  acrid,  aromatic  and  bitter  taste.  The  root  of  the  shops 
is  about  the  size  of  a goose-quill,  of  a grayish  colour,  quadrangular, 
knotted  and  twisted.  It  has  a smell  like  that  of  pepper,  and  a nau- 
seous bitter,  hot,  acrid  taste ; much  of  its  acrimony  being  lost,  how- 
ever, by  drying.  The  acrid  properties  of  the  asarum  would  seem  to 
be  mainly  dependent  upon  liquid  volatile  oil,  and  a camphoraceous 
principle.  It  contains,  moreover,  bitter  extractive. 

Asarabacca  is  an  emetic,  but  is  never  used  as  such.  It  is  only 
employed  as  an  errhine,  and  is  said  to  be  the  basis  of  cephalic  snuff". 
When  either  the  powdered  leaves  or  the  root  are  applied  to  the 
Schneiderian  membrane,  they  excite  sneezing,  an  increased  secre- 
tion of  mucus,  and  may  even  induce  a discharge  of  blood.  The 
quantity  used  as  an  errhine  is  one  or  two  grains  of  the  root,  or  three 
or  four  of  the  leaves,  in  some  cases  of  obstinate  cephalalgia,  chro- 
nic ophthalmia,  or  tooth-ache. 

The  Dublin  Pharmacopoeia  has  a Pulvis  asari  compositus,  com- 
posed of  asarum^  §j  ; lavender  flowers^  5j  ; which  is  used  in  the 
same  cases  in  the  quantity  of  gr.  v to  gr.  viij. 

5.  TAB'ACUM.  — TOBAC'CO. 

Tobacco,  in  the  form  of  snuff,  is  a well  known  errhine  ; not,  how- 
ever, habitually  employed  with  that  view,  but  as  one  form  of  induc- 
ing pleasurable  excitement  through  its  peculiar  impression  on  the 
olfactory  nerves. 

In  the  manufacture  of  snuff,  the  tobacco  is  cut  into  small  pieces  ; 
is  first  fermented  by  being  placed  in  heaps,  and  sprinkled  with 
water  or  a solution  of  salt  — the  latter  preventing  the  tobacco  from 
becoming  mouldy.  The  heaps  soon  become  hot,  and  evolve  am- 
monia. The  extent  to  which  this  process  is  permitted  to  go  varies, 
according  to  the  kind  of  snuff,  from  one  month  to  two  or  three  — 
the  latter  being  the  usual  period.  It  is  then  ground  in  mills,  or  pow- 
dered with  a kind  of  pestle  and  mortar.  Some  of  the  snuffs — as 
the  Scotch.^  Irish,  Welsh  and  Spanish — are  high  dried.  Others  — 
as  the  different  varieties  of  Rappees  — are  moist. 

Of  the  effects  of  the  abuse  of  snuff  on  the  system,  the  author  has 
treated  in  another  work,  [Human  Health,  p.  334.  Philad.  1844.)  In 
this  place  it  has  only  to  be  spoken  of  as  a therapeutical  agent.  To 
those  who  are  unaccustomed  to  its  use,  it  occasions  an  increased 
secretion  of  the  nasal  mucus  and  sternutation.  Where  slight  and 
transient  effects  of  this  kind  are  needed,  snuff  may  be  employed,  but 
it  is  a far  less  energetic  errhine  than  others  in  the  list. 

Besides  the  errhines  mentioned,  others  have  been  occasionally 
employed. 

6.  Euphor'bium.  — This  is  the  concrete  resinous  juice  of  an  un- 
determined species  of  Euphor'bia,  which  is  obtained  in  Morocco, 


SIALOGOGUES. 


261 


and  exported  from  Mogadore.  It  causes  obstinate  sneezing,  dis- 
charge of  bloody  mucus,  and  great  torture,  if  snuffed  up  the  nostrils  ; 
and,  therefore,  requires  to  be  diluted  with  some  mild,  feculaceous 
powder.  It  is  rarely,  however,  used,  and  is  not  in  the  lists  of  the 
Pharmacopceia  of  the  United  States. 

7.  The  root  of  Iris  Florenti'na  or  Florentine  Orm,  Sex.  Syst. 
Triandria  Monogynia ; Nat.  Ord.  Iridacese.  8.  Rosmari'nus  or 
Rose'mary,  9.  Lavan'dula  or  Lavender  ; and  10.  Orig'anum  Ma- 
jora'na  or  Sweet  Marjoram',  Sex.  Syst.  Didynamia  Gymnospermia  : 
Nat.  Ord.  Labiatae ; have  been  classed  amongst  the  errhines,  and 
may  act  as  such  by  virtue  of  the  essential  oil  which  they  contain ; 
but  they  are  more  employed,  on  account  of  their  aromatic  proper- 
ties, as  adjuncts  to  errhines  of  a more  powerful  character.  Dried 
lavender  flowers  are  a constituent  of  the  Pulvis  Asari  compositus  of 
the  Dublin  Pharmacopceia. 


II.  SIAL'OGOGUES. 

Synon.  Ptyalogogues,  ptyusmagogiies,  salivants,  apophlegmatismi  seu  apophleg- 
matisantia  per  os. 

Definition  of  sialogogues — Their  employment  limited — Modus  operand!  of  sialogogues — 
' Mercury  as  a sialogogue — Special  sialogogues. 

Sialogogues  are  agents,  that  increase  the  salivary  discharge. 
The  general  modus  operandi  of  local  sialogogues  or  masticato- 
ries  is  analogous  to  that  of  errhines.  By  their  excitant  properties, 
they  irritate  the  lining  membrane  of  the  mouth,  and  the  irritation, 
thus  induced,  is  extended  along  the  ducts  to  the  salivary  glands  ; so 
that  not  only  is  the  quantity  of  fluid  inhaled  from  the  mucous  mem- 
branes increased,  but  salivation  results.  In  this  way,  depletion 
follows  their  employment,  and  more  or  less  revulsive  effect  super- 
venes, which  may  act  beneficially  on  parts  at  a distance  labouring 
under  disease.  Occasionally,  also,  they  may  prove  useful,  as  in 
cases  of  paralysis  of  the  muscles  of  the  tongue,  by  their  directly  ex- 
citant properties.  It  is  obvious,  however,  that  they  cannot  be  of 
benefit  except  in  local  palsy  of  the  organ.  Where  the  origin  of 
the  disease  is  cerebral,  little  or  no  advantage  can  be  expected  from 
them. 

Therapeutical  application  of  Sialogogues. 

The  employment  of  sialogogues  must  necessarily  be  extremely 
limited.  They  are  occasionally  used  as  raasticatories  in  toothache 
and  in  head  affections^  — precisely,  indeed,  in  the  cases  that  are 
considered  to  indicate  the  use  of  substances,  which  excite  irritation 
in,  and  increased  discharge  from  the  lining  membrane  of  the  nasal 
cavities. 

By  some  writers  on  Therapeutics,  mercury  has  been  ranked 


262 


SPECIAL  SIALOGOGUES. 


amongst  the  sialogogues,  and  salivation  is  certainly  one  of  the  effects 
resulting  from  its  administration.  It  is  now,  however,  generally 
admitted,  that  this  result  is  never  necessary,  and  that  it  is  rather  to 
be  deplored,  inasmuch  as  the  increased  discharge  exhausts  and 
irritates,  without  producing  any  benefit  whatever.  When  this  potent 
article  of  the  materia  rnedica  is  duly  exhibited,  it  induces  a new  ac- 
tion, not  only  in  the  salivary  glands,  but  in  every  part  of  the  glan- 
dular and  follicular,  and,  perhaps  of  the  whole  secretory  system  ; 
and  as  this  new  action  is  incompatible  with  the  one  that  may  be 
already  existing,  the  latter  yields.  In  this  point  of  view,  therefore, 
mercury  is  a revellent,  and  is  referred  to  elsewhere.  Ptyalism  may 
likewise  be  induced  by  various  other  agents  — as  by  iodine,  the 
preparations  of  gold,  copper,  antimony,  arsenic,  and  it  is  said  to 
have  followed  the  employment  of  castor  oil,  digitalis,  and  opium. 
Medicines,  which  act  in  this  manner,  have  been  termed,  specific  or 
remote  sialogogues. 


SPECIAL  SIALOGOGUES. 

1.  PYR'ETHRUM.  — PEL'LITORY. 

The  Mn'themis  Pyr'ethrum,  Anacyc'lus  Pyr’ethrum  or  Pel'litory  of 
Spain;  Sex.  Syst.  Syngenesia  Polygamia  superflua  ; Nat.  Ord. 
Compositae,  is  an  inhabitant  of  Arabia,  Syria,  and  of  France,  Italy, 
Germany,  and  other  parts  of  Europe.  The  root  is  the  officinal  por- 
tion ; but  none  of  it  appears  to  have  been  imported  into  England 
from  the  Levant  since  the  year  1836,  during  which  year  duty  was 
paid  on  420  lbs.  (Pereira.)  It  has,  indeed,  fallen  into  disuse,  and 
has  been  placed  on  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States. 

The  root,  as  met  with  in  the  shops,  is  in  pieces  about  the  length 
and  thickness  of  the  little  finger  ; of  a brown  colour  externally  ; 
mottled  with  black  shining  spots  ; breaking  with  a resinous  fracture, 
and  having  a radiated  structure  internally.  It  is  inodorous,  and, 
when  chewed,  occasions  a peculiar  sense  of  heat,  pungency  and 
tingling  in  the  mouth,  which  continues  for  some  time,  and  is  accom- 
panied by  a copious  flow  of  saliva. 

Its  properties  appear  to  be  dependent  upon  a brown  acrid  resin, 
an  acrid  brown  fixed  oil,  and  a yellow  acrid  oil,  which  have  been 
termed  collectively  Pyr’ethrin : as,  however,  Hagen  and  Schon- 
wald  have  obtained  from  it  a scentless  volatile  oil,  possessing  the 
peculiar  taste  of  the  root,  it  has  been  thought  probable,  that  this  is 
the  active  principle,  and  that  it  adheres  forcibly  to  the  resin  and 
fixed  oil.  (Christison.) 

Pellitory  root  is  employed  almost  exclusively  as  a sialogogue 
in  certain  neuralgic  affections  of  the  head  and  face,  in  palsy  of  the 
tongue,  and  of  the  muscles  of  deglutition  ; and,  occasionally,  both 


ARMORACIA. 


263 


as  a masticatory,  and,  in  the  form  of  infusion^  in  relaxation  of  the 
uvula  and  isthmus  faucium.  It  has  been  much  used  as  a mastica- 
tory in  toothache,  as  well  as  in  the  form  of  tincture.  {Pyrethr., 
JlqucB,  aa  p.  i ; Alcohol,  p.  v.) 

2.  MEZE'REUM.— MEZE'REON. 

Mezereon  bark,  whose  properties  are  described  elsewhere,  owes 
its  excitant  action  to  an  acrid  resin,  by  virtue  of  which  it  is  a good 
masticatory,  and  has  been  used  as  such  in  cases  of  toothache — a 
small  portion  of  the  bark  being  kept  constantly  in  the  mouth,  and 
the  saliva  being  ejected  as  it  is  secreted,  on  account  of  the  inju- 
rious effects  likely  to  be  induced  on  the  digestive  mucous  membrane, 
should  it  be  swallowed.  In  a case  of  dysphagia,  induced  by  para- 
lysis of  three  years’  standing,  mezereon  root  was  prescribed  as  a 
masticatory,  and  in  less  than  a month  the  patient  recovered  the  power 
of  deglutition. 

3.  CAL'AMUS.  — SWEET  FLAG. 

The  general  properties  of  the  rhizoma  of  Adorns  Cal'amus  are 
described  under  the  head  of  Excitants.  Its  medicinal  agency  is 
dependent  upon  volatile  oil.  When  chewed,  it  produces  the  ordi- 
nary excitant  effects  of  the  sialogogues  in  general,  hence  it  is  sub- 
stituted for  tobacco  by  such  as  are  desirous  of  discontinuing  the  use 
of  the  latter.  It  need  scarcely  be  said,  however,  that  the  two  agents 
resemble  each  other  only  in  their  operation  as  local  excitants.  The 
calamus  is  possessed  of  no  narcotic  properties.  It  may  be  used 
whenever  a masticatory  is  needed. 

4.  ARMORA'CIA.  — HORSERADISH. 

Horseradish  is  the  fresh  root  of  CochleaJria  Armora' cia  ; Sex. 
Syst.  Tetradynamia  Siliculosa  ; Nat.  Ord.  Cruciferae  or  Brassica- 
ceae  ; — a native  of  western  Europe,  growing  wild  on  the  sides  of 
ditches,  and  other  moist  situations,  and  flowering  in  June.  It  is 
cultivated  almost  every  where. 

Horseradish  root,  scraped,  is  a well-known  condiment ; has  a 
pungent  taste,  and  exhales  a highly  penetrating  acrid  vapour.  These 
properties  appear  to  reside  in  an  exceedingly  pungent,  acrid,  diffu- 
sible volatile  oil,  which  is  present  in  small  proportion  ; according  to 
one  experimenter  (Duncan)  cited  by  Dr.  Christison,  forming  not 
more  than  four  parts  in  a thousand ; whilst  another  (Gutret)  got 
scarcely  a sixth  part  of  that  proportion.  It  is  difficult,  however,  to 
conceive,  that  so  small  a quantity  of  the  acrid  principle  can  produce 
so  much  excitation. 

The  odour  of  the  oil,  obtained  by  distillation  without  water,  is 
extremely  powerful,  and  like  that  of  horseradish  : a single  drop  is 
sufficient  to  impregnate  the  air  of  a whole  room. 

Horseradish  has  been  used  as  a masticatory  in  cases  of  paralysis 
of  the  tongue.  It  powerfully  excites  the  nerves  of  the  lining  mem- 


264 


DIURETICS. 


brane  of  the  mouth,  and,  through  it,  the  salivary  glands,  which  aug- 
ment their  secretion.  It  is  by  virtue  of  its  excitant  agency,  that  it 
is  serviceable,  when  made  into  a syrup^  in  certain  cases  of  aphonia, 
dysphonia,  or  hoarseness,  where  the  affection  is  dependent  upon 
want  of  power  in  the  nerves  concerned  in  phonation,  or  upon  a state 
of  the  intrinsic  organs  of  voice,  which  excitants  are  capable  of 
benefiting. 

5.  ZIN'GIBER.  — GINGER. 

The  rhizoma  of  Zin^ giber  qfficina'le — which  is  described  else- 
where— when  chewed,  occasions  an  increased  flow  of  saliva.  It 
has  been  used  as  a masticatory  in  paralysis  of  the  tongue  and  of  the 
muscles  of  deglutition. 

6.  TAB'ACUM.  — TOBAC'CO. 

Tobacco  is  a well-known  masticatory  and  sialogogue  ; but  it  dif- 
fers from  the  other  articles  of  the  class,  in  possessing  peculiar  pro- 
perties by  which  it  acts,  when  swallowed,  on  the  nervous  system, 
and  — as  has  been  seen  elsewhere  — powerfully  depresses  the  powd- 
ers of  the  organism.  When  used,  therefore,  simply  as  a sialogogue, 
the  saliva  ought  not  to  be  swallowed.  Indeed,  there  are  few  per- 
sons, who  have  been  in  the  habit  of  chewing  tobacco  largely,  that 
can  swallow  any  portion  of  the  juice  with  impunity. 

Tobacco  is  sometimes  chewed  to  relieve  toothache,  and  a portion 
of  the  relief  obtained  is,  doubtless,  owing  to  the  action  of  the  nar- 
cotic principle.  It  is  not,  however,  an  agent  which  is  easy  of  ma- 
nagement in  those  who  are  unaccustomed  to  it ; and  they,  who  are 
in  the  habit  of  chewing  it,  receive  little  if  any  benefit  from  it.  It  is 
properly  considered  to  be  contra-indicated  in  paralysis  of  the  tongue, 
and  of  the  organs  of  deglutition.  The  simply  excitant  mastica- 
tories  are  to  be  preferred. 


III.  DIURET'ICS. 

Syiton.  Ureiics. 

Definition  of  diuretics — -Their  modus  operandi  — Mental  diuretics  — Therapeutical 
employment  of  diuretics  — In  dropsies  — In  various  chronic  diseases  — Special 
diuretics. 

Diuretics  are  agents  that  increase  the  urinary  discharge. 

Direct  diuretics  are  such  as  act  immediately  and  specially  on  the 
kidney,  so  as  to  increase  its  secretion,  and  to  these  the  term  is  more 
particularly  appropriated.  As  in  other  cases,  however,  it  has  been 
extended,  so  as  to  include  any  agency,  that  may  indirectly  produce 
diuresis.  Thus,  diluents  may  become  diuretics,  by  increasing  the 
mass  of  the  circulating  fluid,  and,  of  consequence,  the  quantity  of 
urine; — in  other  words,  by  occasioning  the  elimination  of  that. 


MODUS  OPERANDI. 


265 


which  has  been  artificially  introduced  ; and,  in  the  same  manner,  a 
cool  temperature,  by  diminishing  the  amount  of  the  cutaneous  and 
pulmonary  depurations,  may  augment  that  which  is  effected  by  the 
urinary  organs.  If,  too,  any  inflammatory  condition  of  the  kidneys 
exists,  blood-letting,  although  it  diminishes  the  amount  of  circulating 
fluid,  may  restore  the  diminished  renal  secretion  ; but  it  is  unneces- 
sary to  go  into  the  consideration  of  the  various  agencies  that  may 
prove  indirectly  diuretic  : they  will  suggest  themselves  readily  to 
the  pathological  inquirer.  The  object,  at  present,  is  to  investigate 
the  modus  operandi,  and  applicability,  of  substances,  that  belong 
strictly  to  the  class  of  diuretics;  — and  which,  if  injected  into  the 
blood  in  appropriate  doses,  will  seek  out  the  urinary  organs,  and 
exert  on  them  their  operation  ; — “ in  appropriate  doses,’’  because 
many  of  them,  — as  cantharides,  and  turpentine,  — if  given  in  too 
great  quantity,  may  induce  nephritis,  and  heematuria,  without  in  any 
manner  augmenting  the  urinary  depuration. 

Under  ordinary  circumstances,  it  is  necessary,  that  a certain  quan- 
tity of  urea,  or  its  elements,  should  be  separated  from  the  blood  ; 
otherwise,  disease  and  death  may  ensue.  Accordingly,  whenever 
the  urinary  secretion  is  suppressed,  in  protracted  or  acute  diseases,  it 
is  an  unfavourable,  and,  in  many  cases,  a fatal  symptom,  inasmuch 
as  it  exhibits  a total  revolution  in  the  accomplishment  of  indispen- 
sable functions,  and  one  not  likely  to  admit  of  restoration.  There 
are,  however,  anomalous  cases  on  record,  in  which  the  urinary 
depuration  has  not  taken  place  for  years  together  ; and,  in  the 
“ Philosophical  Transactions^'^’’  for  1713,  Dr.  Richardson  gives  the 
case  of  a youth  — seventeen  years  of  age — who  had  never  passed 
any  urine,  and  yet  suffered  no  inconvenience.  Where  this  has  re- 
sulted from  malformation, — as  in  the  last  case,  — it  may  be  con- 
ceived, that  the  function  might  be  supplied  through  some  other 
channel, — knowing,  as  we  do,  the  surprising  instances  of  a similar 
kind  met  with  in  certain  cases  of  monstrosity  ; but  it  is  not  so  easy 
for  us  to  comprehend  those  cases,  in  which  the  depuration,  — after 
having  been  established  for  a length  of  time,  — has  become  entirely 
arrested,  and  with  apparent  impunity.  Allusion  has  already  been 
made  to  the  compensation  that  appears  to  exist  between  the  two 
great  depurations  — urinary  and  cutaneous.  3'his  compensation  is 
such,  that  if  the  one  be  diminished  from  any  cause,  the  other  is 
proportionably  increased  ; and  it  is  probable,  that  when  the  urinary 
depuration  is  diminished,  some  of  the  principles  may  pass  off’  by 
perspiration,  as  urea  has  been  detected  in  the  fluid  of  the  cutaneous 
exhalation.  Perhaps,  too,  in  those  diseases,  in  which  we  are  in  the 
habit,  and  with  propriety,  of  regarding  suppression  of  the  urinary 
secretion  as  a fatal  symptom,  the  mischief  arises  less  from  the  reten- 
tion of  matters  that  ought  to  be  evacuated,  than  from  the  deranged 
state  of  the  system  — the  complete  boulcvcrscmcnt  of  functions  — 
which  the  suppression  announces. 

Of  the  different  substances,  ranked  under  the  head  of  diuretics, 
VOL.  I. — 23 


266 


DIURETICS. 


some  pass  into  the  mass  of  blood,  and  proceed  to  the  kidneys,  with- 
out experiencing  any  decomposition;  others,  on  the  contrary,  un- 
dergo changes  in  the  first  passages,  and  it  is  the  result  only  of  such 
changes,  that  excites  diuresis.  To  the  first  class  belong  — amongst 
other  substances  — potassa,  dilute  mineral  acids,  nitrate  of  potassa, 
the  oils  of  turpentine,  juniper,  &c.  The  feaster  on  garlic  and  aspa- 
ragus is  reminded,  by  the  odour  of  the  urine,  of  the  kind  of  vege- 
table that  has  ministered  to  his  repast ; but  these  are  more  properly 
examples  of  the  separation  of  the  odorous  principles  in  the  first  pas- 
sages. 

Reference  has  already  been  made  to  the  opinion  maintained,  — 
that,  when  acetic  acid  is  united  to  potassa,  as  in  the  acetate  of  po- 
tassa, a separation  of  the  constituents  takes  place  in  the  stomach, 
the  potassa  being  set  free,  and  the  acetic  acid  digested,  — and  it 
was  remarked  on  that  occasion,  that  as  the  chlorohydric  acid  exists, 
in  a state  of  health,  in  the  gastric  secretions,  should  any  such  sepa- 
ration take  place,  the  potassa  would  be  laid  hold  of  by  this  acid,  and 
chloride  of  potassium  be  formed,  which  would  enter  the  circulation 
unchanged.  The  same  may  be  said  of  the  potassa,  and  its  alkaline 
fellows,  when  united  to  other  vegetable  acids.  Our  knowledge, 
however,  on  this  point  of  animal  chemistry  is  not  very  precise,  and 
many  of  our  ideas  are  probably  inaccurate.  This  seems  to  be  the 
case  in  respect  to  the  bitartrate  of  potassa,  on  which  Dr.  A,  T. 
Thomson  has  the  following  remarks,  when  speaking  of  it  as  a diu- 
retic. “ Its  effects  in  this  respect  are  explained  by  Dr.  Paris  on  the 
probability  of  the  decomposition  of  the  salt  in  transitu  ; and  con- 
sequently the  conveyance  of  the  alkaline  base  to  the  kidneys.  It  is 
possible,  that  this  explanation  may  be  correct ; but  when  we  consi- 
der that  the  quantity  of  alkali  contained  in  the  dose  of  the  bitartrate 
is  equal  only  to  five  grains,  when  a scruple  of  the  bitartrate  is  taken, 
and  that  seven  grains  of  the  alkali  are  taken  when  twenty  minims  of 
the  liquor  potassae  are  administered,  yet  that  the  effects  of  the  bitar- 
trate are  much  more  considerable  in  producing  diuresis  than  the 
liquor  potassse,  there  is  some  difficulty  in  assenting  to  the  accuracy 
of  this  explanation.”  The  comments  previously  made  regarding  the 
salts  formed  by  a combination  of  a vegetable  acid  with  an  alkaline 
base,  apply  to  this  salt ; and,  if  any  decomposition  be  effected,  it 
must  probably  be  in  part  through  the  agency  of  the  mineral  acid, 
which  is  always  contained  in  the  gastric  juice.  In  the  mode  and 
quantity,  however,  in  which  the  bitartrate  of  potassa  is  usually  taken 
as  a diuretic, — that  is,  in  solution,  in  the  way  of  common  drink  — 
a portion  probably  escapes  any  kind  of  decomposition,  and  passes  to 
the  kidneys  unchanged.  In  the  state  of  solution,  it  is  eminently 
adapted  for  ready  absorption,  and  therefore  is  enabled  to  pass  through 
the  coats  of  the  blood-vessels  of  the  stomach  and  duodenum,  by  im- 
bibition,— in  the  way  in  which  tenuous  fluids  in  general  readily 
enter  the  circulation. 

Of  the  diuretics,  which  are  set  free  in  the  stomach,  — or,  in  other 


MODUS  OPERANDI. 


267 


words,  are  separated  there  from  the  substances  with  which  they  are 
combined,  we  have  marked  examples  in  the  vegetable  substances, 
whose  diuretic  properties  are  dependent  upon  oil  or  oleo-resin  ; — 
as  the  different  turpentines,  copaiba,  cubebs,  juniper  berries,  &c. 
Even  where  essential  oil  is  combined  with  resin  it  is  not  certain,  that 
the  resin  is  not  separated  from  the  oil  by  the  digestive  process,  whilst 
the  latter  only  is  taken  into  the  circulation,  and  proceeds  to  the  kid- 
ney, to  excite  its  appropriate  impression.  In  the  case,  indeed,  of 
every  vegetable,  a separation  must  take  place  in  the  stomach  between 
the  diuretic  and  the  rest  of  its  components  ; and  the  same  applies 
to  the  only  animal  diuretic  in  the  lists  — the  cantharis  or  blistering 
Jly^  — the  active  principle  of  which  — cantharidin  — is  separated 
during  the  digestiv’e  process,  and  probably  alone  enters  the  circula- 
tion, and  proceeds  to  the  urinary  organs. 

Lastly,  certain  mental  emotions  may  be  regarded  as  diuretics : 
these  are  of  the  same  character  as  the  mental  cathartics.  Fear  and 
anxiety  of  mind  are  well  known  agents.  Dr.  Thomson  remarks, 
that  various  sounds  and  even  odours  operate  in  the  same  manner 
through  the  medium  of  the  nerves,  and  refers  to  Shakspeare,  who 
ascribes  this  effect  to  the  sound  of  the  bagpipe  — 

“ And  others,  when  the  bagpipe  sings  i’the  nose, 

Cannot  contain  their  urine.” 

But  these  are  cases,  which  exhibit  the  influence  of  sensations  and 
emotions  on  the  power  of  retention  rather  than  on  that  of  secre- 
tion. The  like  result,  too,  is  produced  by  the  exciting  emotions. 
Excessive  joy  has  given  rise  to  the  same  incontinence  as  exces- 
sive dread  ; a fact  well  elucidated,  by  Cervantes,  in  the  effect  which 
he  describes  to  have  been  produced  on  Sancho’s  daughter,  when 
the  joyful  tidings  were  communicated  to  her,  that  her  father  had 
been  made  governor  of  Barataria ! 

By  occasioning  a copious  discharge  of  the  more  fluid  portions 
of  the  blood,  diuretics  are,  to  a certain  extent,  evacuants,  but  they 
are  rarely  employed  as  such,  unless  for  the  purpose  of  occasioning 
greater  activity  of  absorption,  as  in  cases  where  an  undue  exhala- 
tion or  accumulation  of  fluid  has  taken  place  into  one  or  more  of 
the  serous  cavities.  In  other  words,  diuretics  are  rarely  employed 
as  depletives,  where  antiphlogistics  are  indicated.  Their  effect  is 
too  trivial  to  make  any  decided  impression. 

It  is  perhaps  by  their  revulsive  action,  combined  with  the  diuresis, 
that  they  are  beneficial  in  certain  diseases.  The  diuresis  itself  is  a 
sufficient  evidence  of  their  operation  as  local  excitants,  even  were 
we  not  aware,  that  nephritis,  or  heematuria,  or  both,  frequently  re- 
sult from  their  administration  in  too  large  a dose, — a fact,  which 
it  is  important  to  bear  in  mind  in  affections  of  the  kidney,  accom- 
panied by  inflammation,  and  diminished  urinary  secretion,  in  which, 
from  an  attention  to  the  latter  circumstance  only,  their  employment 
might  seem  to  be  clearly  indicated.  In  such  affections,  they  could 


268 


DIURETICS. 


not  fail  to  add  to  the  mischief,  and  the  best  diuretics  would  ob- 
viously be — the  lancet  and  the  antiphlogistic  medication,  which, 
by  removing  the  pathological  cause  of  the  diminished  secretion, 
would  give  indirect  occasion  to  its  restoration. 

Therapeutical  Application  of  Diuretics. 

Febrile  and  inflammatory  affections.  — From  what  has  been  said, 
then,  of  the  properties  of  diuretics,  their  therapeutical  employment 
will  be  readily  intelligible.  Much  benefit  cannot,  of  course,  be  ex- 
pected from  them  in  febrile  affections,  or  in  internal  inflammations 
of  parts  at  a distance  from  the  urinary  organs ; and  it  would  ob- 
viously be  improper  to  administer  any  but  simple  diluents,  where 
the  kidney  is  suffering  under  inflammatory  irritation.  It  has  been 
already  remarked,  that,  as  simple  evacuants,  not  much  reliance  can 
be  placed  upon  them  : we  have  other  depletives  infinitely  more  effec- 
tive in  such  cases. 

Dropsies.  — The  chief  diseases  in  which  diuretics  are  prescribed 
are  those  of  a dropsical  character ; especially  of  the  abdomen  or 
cellular  membrane.  By  augmenting  the  secretion  from  the  kidneys, 
the  quantity  of  circulating  fluid  is  necessarily  diminished  ; imbibi- 
tion is  augmented  ; the  fluid  of  the  dropsy  soaks  through  the  parietes 
of  the  blood-vessels,  and,  in  this  way,  such  collections  maybe  made 
to  disappear.  It  is  probable,  too,  that  an  essential  part  of  the  effect 
is  dependent  upon  the  revulsive  operation  of  the  diuretic.  Acting 
as  a local  excitant  to  the  kidney,  it  occasions  an  afflux  of  vital 
energy  to  the  organ,  and  thus  diminishes  the  too  great  exhalation 
from  the  vessels  of  the  serous  membrane.  Reliance  is,  however, 
rarely  placed  upon  the  administration  of  diuretics  alone  in  dropsy. 
The  precise  pathological  condition,  which  gives  rise  to  it,  has  to  be 
attentively  investigated,  and  an  appropriate  system  of  medication  to 
be  united  with  the  diuretic.  Thus,  the  dropsy  is  often  manifestly 
of  an  active  or  sthenic  character,  so  that  blood-letting  or  cathartics, 
or  both,  are  indicated,  and,  these  being  premised,  more  benefit  may 
accrue  from  the  diuresis  than  would  otherwise  have  resulted.  Fre- 
quently, in  such  cases,  a combination  of  agents  of  another  character 
with  diuretics  may  be  used  with  great  advantage.  Mercury  is  an 
excitant  of  the  secretory  system  ; squill  is  a diuretic ; their  conjoint 
action  will,  therefore,  be  as  follows  : — the  mercury  produces  an 
action  of  revulsion,  — a distraction  of  vital  manifestation  from  the 
seat  of  the  dropsical  affection  to  the  parts  on  which  it  exerts  its 
local  stimulation,  — the  exhalation  from  the  serous  membrane  is 
consequently  reduced  even  below  the  healthy  point ; a similar  in- 
fluence is  exerted  by  the  local  stimulation  of  the  diuretic,  whilst,  in 
addition,  under  its  operation  the  absorbed  fluid  is  discharged. 
Hence,  a combination  of  mercury  with  digitalis,  squill,  or  some 
other  diuretic,  is  one  of  the  most  useful  and  most  common  prescrip- 
tions in  dropsical  cases. 


SPECIAL  DIURETICS. 


269 


It  is  obvious,  that  diuretics  can  never  be  productive  of  essential 
benefit,  where  organic  mischief  exists  in  any  of  the  viscera.  Im- 
peded circulation  in  the  viscera  gives  occasion  to  the  worst  forms 
of  dropsy,  as  the  visceral  mischief  does  not  usually  admit  of  remedy. 
Of  this  nature  is  the  organic  disease  of  the  kidney,  to  which  atten- 
tion was  originally  directed  by  Dr.  Bright,  in  the  first  volume  of  his 
Reports, and  which  is  distinguished  by  the  coagulable  state  of  the 
urine — albuminuria.  This  is  often  accompanied  by  dropsy,  al- 
though not  always.  In  such  cases,  the  author  has  been  very  cau- 
tious in  the  administration  of  excitant  diuretics,  under  the  appre- 
hension, that  they  might  add  to  the  irritation  already  present  in  the 
kidneys.  Tt  is  proper,  however,  to  observe,  that  they  have  not  been 
regarded  by  some  as  contra-indicated  in  these  very  cases.  Dr. 
Christison  thinks,  that  a stimulus  of  one  kind  may  be  employed 
with  impunity,  and  even  with  advantage,  when  an  organ  is  labour- 
ing under  irritation  of  a different  kind ; and  he  affirms,  that  diuretics 
do  not  augment  the  quantity  of  albumen  in  the  urine,  the  amount  of 
which  has  been  generally  regarded  as  an  index  of  the  degree  of 
local  irritation.  He  considers  the  best  combination  in  such  dropsi- 
cal cases,  to  be  — digitalis,  a sedative  diuretic,  with  bitartrate  of 
potassa,  an  excitant  diuretic,  — the  efficacy  of  the  diuretic  in  such 
cases  being  increased  by  the  use  of  an  emetic  or  brisk  cathartic. 

Rheumatic  affections.  — Diuretics  have  been  frequently  recom- 
mended in  various  chronic  diseases,  especially  of  a rheumatic  na- 
ture. In  lumbago  and  sciatica,  the  oils  of  the  different  terebin- 
thinates,  as  well  as  the  terebinthinates  themselves,  have  been  much 
used,  and,  at  times,  with  marked  advantage  ; but  their  modus 
operandi  is  probably  altogether  revellent, — ■ not  from  the  diuresis  they 
occasion. 

On  the  whole,  therefore,  the  class  of  diuretics,  although  often  had 
recourse  to  by  the  practitioner,  cannot  be  considered  to  comprise 
our  most  efficacious  agents  in  the  management  of  disease.  They  are 
applicable  to  but  few  morbid  conditions,  and  many  of  these  can  be 
as  well  treated  by  other  remedies.  Accordingly,  they  are  by  no 
means  as  often  employed  at  the  present  day  as  they  were  formerly. 


SPECIAL  DIURETICS. 

These  may  be  divided  into  two  classes.  1.  Excitant  Diuretics, 
and  2.  Sedative  Diuretics ; the  former  clearly  acting  as  excitants  to 
the  kidneys,  and  not,  therefore,  well  adapted  when  there  is  any  in- 
flammatory condition  of  those  organs ; the  latter  acting  more,  per- 
haps, upon  the  organic  actions  generally,  diminishing  the  power  of 
the  heart  and  arteries,  and  therefore  well  adapted  for  sthenic  drop- 
sies. These  substances  seem  to  act  but  slightly  on  the  kidneys  as 
23^ 


270 


SPECIAL  DIURETICS. 


true  diuretics,  and  it  has  even  been  objected  to  ranking  digitalis 
amongst  the  diuretics,  — that  its  action  seems  to  consist  in  remov- 
ing the  cause  of  the  dropsy,  the  fluid  being  then  carried  off  in  the 
usual  manner,  so  that  it  is  no  more  a diuretic  than  quinia,  in  drop- 
sies caused  by  intermittents.  (Wohler  cited  by  J.  Muller.)  It  is 
probable,  however,  that  not  only  digitalis,  but  the  other  agents, 
classed  as  sedative  diuretics,  are  capable  of  acting  directly  upon  the 
kidneys  so  as  to  increase  the  secretion  from  them. 

I.  Excitant  Diuretics, 

1.  JUNIP'ERUS.  — JU'NIPER. 

The  excitant  properties  of  juniper  are  described  elsewhere.  These 
are  shown  to  be  dependent  upon  its  volatile  oil — the  0 'LEUM  JMP'ERI. 
The  diuretic  virtue  is  dependent  upon  the  same ; and  according  to 
some  experiments,  in  the  dose  of  four  drops,  which  maybe  given  in 
sugar,  it  is  one  of  the  most  certain  of  diuretics.  A recent  writer, 
Dr.  Christison,  states,  that  he  has  found  five  minims  of  the  oi/,  mixed 
with  a fluidrachm  of  spirit  of  nitric  ether^  given  three  times  a day  in 
any  common  vehicle,  produce  diuresis  in  dropsy,  when  other  means 
had  failed. 

The  berries,  when  eaten,  affect  the  urinary  organs,  increasing  the 
secretion  from  the  kidneys  ; and,  in  large  doses,  producing  renal 
and  vesical  irritation.  The  urine  acquires  a violet  odour  under  their 
use.  They  are  occasionally  given  as  a diuretic  in  dropsy,  but  are 
rarely  trusted  to  alone.  They  may  be  rubbed  up  with  sugar,  and 
taken  in  the  dose  of  a drachm  or  two,  three  or  four  times  a day. 
This,  however,  is  not  the  form  in  which  they  are  usually  prescribed. 
The  author  is  constantly  in  the  habit  of  directing  them  to  be  taken 
in  infusion  as  common  drink.  This  may  be  made  by  pouring  on 
an  ounce  of  the  berries  a pint  of  boiling  water,  letting  it  stand  till 
cold,  and  taking  the  whole  pint  in  the  course  of  the  twenty-four 
hours.  Where  the  diuretic  agency  of  bitartrate  of  potassa  seems  to 
be  indicated,  two  drachms  of  it  may  be  added  to  the  juniper  berries 
prior  to  infusing  them. 

SPIR'ITUS  JUNIP'ERI  COMPOS'ITUS,  COMPOUND  SPIRIT  OF  JU'NIPER.  [Juni- 
per. contus.  JU)j  ; carui  contus.,  foeniculi  contus.  aa  §iss  ; Alcohol, 
dilut.  cong.  ; Aqucx.,  Oij.) 

This  spirit,  when  sweetened,  has  been  regarded  as  a substitute 
for  Hollands j and  for  common  gin,  both  of  which  contain  oil  of  ju- 
niper ; and  hence  gin  toddy,  or  hot  gin  and  water,  is  occasionally 
j)rescribed  to  hydropics  as  a diuretic.  The  combination  of  carraway 
and  fennel  seeds  adapts  it  more  for  an  excitant  and  carminative  ; but 
still,  on  account  of  the  juniper  berries,  it  is  most  commonly  used  as 
an  adjunct  to  diuretic  mixtures.  It  is  rarely  given  alone.  Its  dose 
is  f.  5ii  to  f.  3iv,  and  both  it  and  the  spirituous  liquors  named  above 
may  be  of  service  in  highly  asthenic  cases  of  dropsy. 


SCILLA. 


271 


2.  SCOPA'RIUS.  — BROOM. 

The  fresh  tops  of  Cyt'isus  Scopa'rius,  Spar'tium  ScopaWium  or 
common  broom  ; Sex.  Syst.  Diadelphia  Decandria  ; Nat.  Ord.  Le- 
guminosae,  are  in  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States,  into  which  they  have  been  admitted  on  account  of 
their  diuretic  properties. 

Broom,  — a shrub  from  three  to  six  feet  high,  and  flowering  in 
June,  — is  indigenous  in  Europe,  and  cultivated  in  this  country  as 
an  ornament  to  the  gardens.  The  tops  have  a bitter,  nauseous  taste ; 
and,  when  bruised  in  their  fresh  state,  a strong  peculiar  odour.  The 
seeds  possess  similar  properties,  and  their  virtues  are  yielded  to  both 
water  and  alcohol. 

Although  broom  has  been  placed  in  the  secondary  list  of  the  Phar- 
macopoeia of  the  United  States,  and  is  but  little  prescribed  by  the 
physicians  in  this  country,  it  is  highly  extolled,  and  placed  in  the 
first  rank  of  the  diuretics  by  some  practitioners.  Dr.  Pereira,  for  ex- 
ample, affirms,  that  having  very  frequently  employed  it  in  dropsies, 
he  can  add  his  testimony  to  its  powerful  effects  as  a diuretic,  and 
that  he  cannot  call  to  mind  a single  case  in  which  it  has  failed  to  act 
on  the  kidneys.  In  some  cases,  it  produced  a most  marked  and 
beneficial  influence  on  the  dropsical  effusion,  and,  in  his  opinion,  it 
is  more  certain  than  any  other  diuretic  in  dropsies. 

Owing  to  its  bitter  principle,  it  is  at  the  same  time  tonic  ; and, 
consequently,  adapted  for  cases  in  which  the  union  of  a tonic  and 
a diuretic  is  needed,  as  in  the  asthenic  forms  of  dropsy.  When  given 
in  too  large  a dose,  it  acts  both  as  a cathartic  and  an  emetic. 

The  London  Pharmacopoeia  has  an  Infusum  Scoparii,  (Scopar, 
§j  ; Aquce  hullient.  Oj  ;)  the  dose  of  which,  as  a diuretic,  is  f.  §j.  to 
f.  ^ij  ; — -a  Decoctum  Scoparii  Compositum,  [Scoparii^  Juniper..^ 
Taraxac.j  aa  §ss  ; Aqua:,  Oiss.  Boil  down  to  a pint.  Dose,  f.  to 
f.  §ij  ;)  which  is  a combination  of  diuretics  ; and  the  Dublin  Phar- 
macopoeia a watery  extract  prepared  from  a decoction  of  the  tops  — 
the  Extractum  Spartii  Scoparii — the  dose  of  which  is  from  3ss. 
to  5j ; but  it  is  rarely  prescribed. 

3.  SCILLA.  — SQUILL. 

Squill  — which  has  been  described  under  Emetics  (p.  122) — has 
long  had  the  reputation  of  an  active  diuretic,  and  as  such  has  been 
frequently  prescribed  in  dropsical  cases,  and,  at  the  present  day,  is 
perhaps  employed  as  often  as  any  remedy  belonging  to  the  class.  It 
is  rarely,  however,  given  alone,  being  combined  either  with  other 
diuretics  — as  digitalis,  bitartrate  of  potassa,  or  juniper  berries  — or 
with  a revellent,  as  the  mild  chloride  of  mercury.  It  is  an  excitant 
diuretic,  and  therefore  less  adapted  than  digitalis  for  cases  in  which 
there  is  much  vascular  excitement,  especially  of  the  kidneys.  Its 
dose,  in  substance,  is  one  grain,  repeated  every  four  or  five  hours. 
At  times,  its  diuretic  influence  is  not  exhibited  until  it  has  been 
pushed  so  as  to  induce  nausea. 


272 


SPECIAL  DIURETICS. 


The  dose  of  the  ACE'TUM  SCILLJl,  (p.  122),  as  a diuretic,  is  f.  3SS 
to  f.  3j ; and  of  the  TINCTU'RA  SClLLiE,  (p.  122),  from  tr\^x.  to  tr\^xx. 

4.  CHIMAPH'ILA.—PIPSIS'SEWA. 

The  leaves  of  Chimaph'ila  umbella'ta^  Ch.  corymbo'sa,  Py’rola  um- 
bella'ta^  Pipsis'sewa^  or  umJbellated  winter-green  ; Sex.  Syst.  Decan- 
dria  Monogynia  ; Nat.  Ord.  Pyrolacece^  are  officinal  in  the  Pharma- 
copoeia of  the  United  States ; and  the  whole  herb  in  those  of  Edin- 
burgh and  Dublin.  It  is  a beautiful  evergreen,  and  is  indigenous 
in  the  northern  parts  of  Europe,  Asia,  and  America,  flowering  in 
June  and  July. 

The  leaves  have  a bitter  sweetish  taste,  with  some  degree  of  as- 
tringency.  Boiling  water  and  alcohol  extract  their  virtues.  When 
subjected  to  analysis,  they  yield  bitter  extractive,  resin,  tannic  acid, 
gum,  lignin  and  saline  matters.  It  is  not  determined  in  what  prin- 
ciple the  main  activity  resides,  but,  it  has  been  presumed,  in  the 
bitter  extractive.  The  constituents  would  show,  however,  that  the 
leaves  must  be  tonic,  by  reason  of  the  bitter  principle  ; and  astrin- 
gent by  reason  of  the  tannic  acid.  They  have,  likewise,  a decided 
effect  in  increasing  the  secretion  of  the  kidneys ; and  like  marvel- 
lous virtues  have  been  assigned  to  them,  as  to  diosma  crenata  and 
uva  ursi,  in  diseases  of  the  urinary  organs  in  general  ! It  is  in  dropsy, 
however,  that  the  diuretic  action  of  chimaphila  has  been  most  fre- 
quently serviceable,  and  it  may  be  beneficially  employed  wherever 
a tonico-diuretic  is  indicated.  The  author  has  often  used  it  in  atonic 
dropsy,  and  with  decided  advantage. 

An  extensive  series  of  experiments  was  made  at  the  Burger  hos- 
pital at  Pesth  in  regard  to  its  remedial  powers  in  dropsy.  Within 
two  years,  nearly  200  cases  are  said  to  have  been  radically  cured 
by  it.  . . ^ . 

Chimaphila  is  generally  given  in  decoction,  but  a watery  extract 
is  sometimes  prepared  from  it,  which  may  be  prescribed  in  the  dose 
of  20  or  30  grains,  three  or  four  times  a day. 

DECOC'TUM  CHIMAPiriLl, DECOCTION  OP  PIPSIS'SEWA.  {Chimaphil.  cont. 

; Aquce^  Oiss.  Boil  to  a pint.)  The  whole  of  this  may  be  taken 
n 24  hours.  Where  it  is  desirable  to  act,  at  the  same  time,  on  the 
bowels,  senna  leaves  may  be  added. 

5.  CAlN'CJi:  RADIX.  — CAINCA  ROOT. 

Radix  Cain'cce,  R.  Ckiococ'cce^  R.  Caina^nce^  R.  Canina'nce,  R. 
Cahin'cce^  R.  Kahin'cce^  R.  Serpenta' rice  Brazilien'sis,  Cainca  Root, 
is  not  in  the  British  or  American  Pharmacopoeias.  It  is  the  root  of 
Chiococ'ca  anguifuga ; Sex.  Syst.  Pentandria  Monogynia ; Nat. 
Ord.  Rubiacem ; a shrub,  which  grows  wild  in  Brazil,  where  the 
root  is  employed  against  the  bites  of  serpents.  It  is  of  the  thick- 
ness of  the  finger,  round  and  knotty ; the  surface  is  irregularly  wrinkled, 
the  wood  tough,  and  of  a whitish  colour ; the  smell,  especially  of 


SPIRITUS  iETHERIS  NITRICI. 


273 


the  fresh  root,  is  disagreeable,  and  the  taste  at  first  like  that  of  coffee, 
but  afterwards  nauseous  and  pungent.  The  bark  of  the  root  is  alone 
active,  the  woody  portion  being  inert : its  virtues  are  extracted  by 
Avater  and  alcohol. 

Chemical  analysis  has  shown  one  of  its  constituents  to  be  a bitter 
principle,  crystallisable  in  small,  white,  shining  silky  needles,  which 
has  an  acid  reaction,  owing  to  the  existence  of  a peculiar  acid  — the 
Cahincic  acid  — and  in  which  the  medical  virtues  appear  to  reside.  It 
was  found  by  MM.  Pelletier  and  Caventou,  to  contain,  likewise,  a 
fatty,  green,  nauseous  odorous  substance^  which  gives  the  plant  its 
smell ; and  a yellow,  and,  also,  a viscid  colouring  matter. 

The  main  therapeutical  effect  of  Cai'nca  is  exerted  on  the  digestive 
and  urinary  organs.  It  occasions  watery  evacuations,  and  increased 
secretion  of  urine.  It  has  been  doubted,  however,  whether  its  bene- 
ficial effects  in  dropsical  cases  have  not  been  dependent  rather  upon 
its  cathartic  than  its  diuretic  agency.  The  testimony  in  re'gard  to 
its  action  in  dropsy  has  been  discordant,  but  many  have  deposed 
very  strongly  in  its  favour. 

It  is  given  in  various  forms  of  preparation  — powder,  infusion,  de- 
coction, tincture,  extract,  syrup  and  wine.  The  wine  is  formed  from 
one  ounce  of  the  powdered  root  to  a pint  of  wine  ; the  tincture 
from  one  part  of  the  root  to  eight  parts  of  alcohol.  The  dose  of  the 
powder  is  from  9j.  to  ^ss.  in  the  24  hours.  It  appears,  however, 
that  it  gives  rise  to  disagreeable  symptoms  more  frequently  than  the 
other  forms. 

It  is  affirmed,  that  there  is  a remarkable  analogy  between  cainca 
and  apocynum  cannabinum. 

6.  BAL'LOTA  LANA'TA. 

Bal'lota  Lana'ta,  Sex.  Syst.  Didynamia  Gymnospermia;  Nat.  Ord. 
Labiatse,  is  a plant  which  grows  exclusively  and  commonly  in  Si- 
beria ; where  it  has  long  had  great  reputation  in  dropsy.  It  has 
been,  of  late  years,  introduced  into  Russia,  Germany  and  Italy,  but 
has  not  been  employed  in  this  country.  The  whole  plant  is  used, 
except  the  root ; and  ample  testimony  exists  to  show,  that  it  largely 
increases  the  urinary  secretion,  and  has  produced  unequivocally 
good  effects  in  dropsical  cases.  The  form  of  preparation  usually 
prescribed  is  the  decoction.  {Ballot.  Lanat.  jiss  — §ij  ; Mquw 
Oij  ; boil  to  a pint.  Dose,  a cupful,  night  and  morning.) 

7.  SPmaTUS  iE'THERIS  NPTRICI.  — SPIRIT  OF  NITRIC  ETHER. 

The  Spirit  of  JYitric  Ether y Spiritus  JVitri  dulcisy  Sweet  Spirit  of 
JVitrey  JYitre  Drops,  or  — as  it  is  often  called  — Mitre,  is  a mixture 
of  impure  hyponitrous  ether  and  alcohol.  According  to  the  process  of 
the  Edinburgh  Pharmacopoeia,  it  is  formed  by  first  preparing  nitric 
01  hyponitrous  ether,  and  then  diluting  this  with  alcohol.  The 


274 


SPECIAL  DIURETICS. 


PharmocopcBia  of  the  United  States  does  not  generate  the  ether  by 
the  direct  mutual  reaction  of  nitric  acid  and  alcohol ; but  provides 
the  materials  for  the  formation  of  the  nitric  acid,  as  in  the  annexed 
process  : — Take  of  JVitrate  of  potassa^  in  coarse  powder,  ; Sul- 
phuric acid,  p3iss ; Alcohol^  nine  pints  and  a half;  Diluted  alcohol, 
a pint ; Carbonate  of  potassa,  jj  : Mix  the  nitrate  of  potassa  and  the 
alcohol  in  a large  glass  retort,  and,  having  gradually  poured  in  the 
acid,  digest  with  a gentle  heat  for  two  hours  ; then  raise  the  heat 
and  distil  a gallon.  To  the  distilled  liquor  add  the  diluted  alcohol 
and  carbonate  of  potassa,  and  again  distil  a gallon. 

The  redistillation  from  carbonate  of  potassa  is  directed  to  get  rid 
of  some  acid,  which  is  always  contained  in  the  product  of  the  first 
distillation.  Spirit  of  nitric  ether,  thus  obtained,  has  the  specific 
gravity  0*834,  is  colourless,  has  a peculiar  and  fragrant  ethereal 
odour  ; and  a pungent,  slightly  sweet  and  acidulous  taste.  It  red- 
dens litmus  paper,  but  does  not  effervesce  with  carbonate  of  soda  ; 
by  keeping,  however,  it  becomes  decidedly  acid,  and  may  decom- 
pose various  substances,  with  which  it  is  frequently  combined  in 
prescriptions.  To  obviate  this,  it  may  be  kept  on  crystals  of  carbo- 
nate of  potassa.  It  is  very  volatile,  and  therefore,  requires  to  be 
kept  in  well  stopped  bottles.  It  dissolves  in  water  and  alcohol  in 
all  proportions.  It  is  very  extensively  adulterated,  sometimes  with 
three  or  four  times  its  weight  of  alcohol  and  >vater.  Dr.  Pereira 
states,  that  in  July  1840,  Mr.  Hennell,  of  Apothecaries’  Hall,  Lon- 
don, informed  him,  that  it  was  then  selling  in  the  trade  at  a price, 
which  was  but  just  above  that  of  the  duty  on  the  spirit  used  in 
manufacturing  the  genuine  article.  Wholesale  dealers,  too,  are 
said  to  keep  two  or  even  three  qualities  of  the  preparation.  The 
density  and  flavour  will  lead  to  a tolerably  accurate  estimate  of  its 
goodness. 

Spirit  of  nitric  ether  decidedly  increases  the  action  of  the  kidneys  ; 
yet  it  is  rarely  given  alone  in  dropsical  cases  ; and  not  very  often  in 
association.  It  may  be  combined  with  squill,  bitartrate  of  potassa, 
juniper  berries,  &c.  It  must  be  borne  in  mind,  however,  that  it  is 
an  excitant  diuretic,  and  ought,  therefore,  to  be  given  with  caution 
in  dropsies  connected  with  disease  of  the  kidney.  It  is  best  adapted 
for  those  of  the  asthenic  kind.  Its  dose  as  a diuretic  is  from  f.  5SS 
to  f.  5ij,  in  water,  repeated  two  or  three  times  a day. 


SALTS  OF  POTASSA. 

8.  POTAS'SJ3  BITAR'TRAS.  — BITART'RATE  OF  POTAS'SA. 

Bitartrate  of  potassa,  in  small  doses,  is  a diuretic,  and  as  such  is 
used  in  dropsical  cases, — rarely  alone,  sometimes  combined  with  other 
diuretics,  as  squill,  digitalis,  juniper  berries,  &c.  ; at  others,  united 
with  cathartics,  to  which  class  of  medicinal  agents  it  likewise  be- 
longs. (See  page  186.) 


POTASSiE  NITRAS. 


275 


As  a diuretic,  it  may  be  given  in  molasses  in  the  dose  of  a scruple 
to  a drachm,  repeated  two  or  three  times  in  the  twenty^four  hours^ 
This  is  not,  however,  so  good  a form  as  the  solution  of  the  salt,  made 
by  pouring  a quart  of  boiling  water  on  half  an  ounce  of  the  bitar- 
trate, sweetening  with  sugar,  and  flavouring  or  not  with  lemon- 
peel.  This  may  be  taken  freely  as  common  drink  unless  it  should 
act  too  much  upon  the  intestines.  The  ordinary  imperial  is  made 
by  dissolving  a drachm  or  a drachm  and  a half  of  the  bitartrate  in 
a pint  of  boiling  water,  and  adding  lemon-peel  and  sugar.  A cream 
of  tartar  whey  is  made  by  adding  about  two  drachms  of  the  bitartrate 
to  a pint  of  milk,  which  may  be  diluted  with  water,  and  drunk  as  a 
diuretic  in  hydropic  affections.  It  may  also  be  rendered  soluble  by 
borax  or  boracic  acid,  and  be  given  in  this  way. 

9.  POTAS'S^  NITRAS.  — NITRATE  OF  POTAS'SA. 

Nitrate  of  Potassa,  JSPitre  or  Saltpe’tre^  occurs  in  both  the  inor- 
ganic and  the  organised  kingdom.  In  the  former,  it  is  met  with  in 
certain  soils,  efflorescing  on  the  surface  ; in  the  latter,  it  has  been 
found  in  various  plants.  For  the  various  modes  in  which  it  is  ob- 
tained from  its  natural  sources,  as  well  as  artificially,  the  reader  is 
referred  to  chemical  works.  It  is  found  naturally  in  various  parts 
of  the  United  States,  especially  in  the  southern  and  western  portions, 
where  it  occurs,  for  the  most  part,  in  caverns  or  limestone  rock,  called 
saltpetre  cafues^  and  is  associated  with  nitrate  of  lime.  The  earths, 
contained  in  these  caves,  are  lixiviated,  and  yield,  according  to  the 
impregnation,  from  one  to  ten  pounds  of  crude  nitre  to  the  bushel. 
These  caves  are  especially  numerous  in  Kentucky,  and  are  said  to 
have  furnished  a large  portion  of  the  nitre  used  in  the  United  States 
during  the  last  war.  (Wood  & Bache.)  The  greater  part  of  the 
nitrate  of  potassa  used  now  in  England  and  in  this  country,  is  ob- 
tained in  various  parts  of  the  East  Indies  by  a similar  kind  of  lixi- 
viation. 

Crude  saltpetre^  as  met  with  in  commerce,  requires  to  be  purified 
for  medicinal  purposes.  This  is  done  by  dissolving  it  in  two  parts 
of  hot  water,  filtering  the  liquor  and  setting  it  aside,  so  that,  on 
cooling,  crystals  may  form. 

Nitrate  of  potassa  is  also  prepared,  in  many  parts  of  Europe, 
from  soils  artificially  impregnated  with  animal  matter,  or  from  the 
mortar  of  old  buildings,  especially  of  the  under-ground  floor,  or  from 
artificial  composts,  consisting  of  animal  substances,  decaying  vege- 
tables, ashes  and  chalk,  marl  or  lime.  The  nitrate,  thus  produced 
in  the  first  place,  is  the  nitrate  of  lime,  which  is  converted  into  ni- 
trate of  potassa  by  the  addition  of  carbonate  of  potassa. 

Nitrate  of  potassa,  as  met  with  in  the  shops,  is  tolerably  pure.  It 
is  in  fragments  of  crystals,  of  considerable  size,  which  are  striated, 
opaque,  colourless,  six-sided  prisms,  terminated  by  one,  two  or  six 
converging  planes.  The  crystals  are  unalterable  in  the  air,  and 


276 


SPECIAL  DIURETICS. 


wholly  soluble  in  water.  They  have  a sharp,  cooling  taste.  The 
salt  is  occasionally  adulterated  with  sulphate  of  potassa,  and  muriate 
of  potassa.  The  sulphate  is  detected  by  a solution  of  the  chloride 
of  barium,  which  occasions  a white  precipitate  of  sulphate  of  baryta  ; 
the  muriate,  by  the  nitrate  of  silver,  which  produces  a white  preci- 
pitate of  chloride  of  silver. 

Nitrate  of  potassa,  besides  its  other  properties,  possesses  those  of 
a diuretic.  It  is  taken  up  into  the  mass  of  blood,  and  is  separated 
by  the  kidneys,  so  that  it  may  be  detected  in  the  urine.  It  is  not 
often,  however,  prescribed  as  a diuretic,  in  consequence  of  there 
being  more  potent  articles  of  the  class.  It  may  be  given  in  the  dose 
of  gr.  X.  to  5ss.  dissolved  in  water,  and  its  action  may  be  facilitated 
by  taking  diluents  freely. 

10.  POTAS'S^  ACE'TAS.— AC"ETATE  OF  POTAS'SA. 

Acetate  of  potassa,  which  was  formerly  termed  Sal  diuret’icus^ 
had  at  one  time  great  reputation  for  its  powers  in  augmenting  the 
urinary  secretion ; but  it  is  not  now  much  employed.  In  large 
doses  — as  elsewhere  shown,  (p.  190,) — it  is  cathartic;  and  may 
produce  a joint  cathartic  and  diuretic  action.  It  was  highly  thought 
of  by  Dr.  Duncan,  jr.,  in  dropsy  ; and  Alibert  considered  it  the  best 
of  diuretics  in  hydrothorax.  It  unquestionably  is  diuretic  in  small 
doses,  and  may,  therefore,  be  serviceable  in  dropsies,  but  it  is  less 
efficacious,  apparently,  than  bitartrate  of  potassa,  which  has  now 
usurped  its  place. 

An  acetate  may  be  made  by  saturating  vinegar  with  the  potassa  of 
the  carbonate  of  potassa. 

Acetate  of  potassa  — as  before  remarked — -must  undergo  decom- 
position in  the  stomach,  if  chlorohydric  acid  be  present,  and  it  is 
affirmed,  that  if  none  should  exist  there,  the  potassa  alone  enters  the 
circulation,  and  is  separated  by  the  kidney.  If  this  explanation  be 
true,  the  diuretic  agency  must  be  ascribed  to  the  potassa,  and  not  to 
the  acetate. 

The  dose,  as  a diuretic,  is  from  gr.  x.  to  gr.  xx.,  given  in  any 
diluent  or  demulcent. 

11.  SALTS  OF  SODA. 

Many  of  the  salts  of  soda  are  diuretic,  but  none  of  them  emi- 
nently so.  The  Borate  — ^ Sod^e  Boras  — - has  been  sometimes  given 
in  dropsy,  in  the  dose  of  ^ss  to  5j,  frequently  repeated  ; the  Carbo- 
nate ‘ — SoDiE  Car'bonas  — in  the  dose  of  gr.  x.  to  3ss;  and  the 
Bicarbonate  — Soda2  Bicar'bonas  ■—  in  the  dose  of  gr.  x.  to  5j  ; but 
they  are  never  trusted  to  alone,  and  it  is  doubtful  whether  they  are 
worthy  of  being  classed  amongst  the  active  diuretics. 

12.  CAN'THAP IS. —SPANISH  FLIES. 

The  Spanish  Fly  or  Blister  Beetle — Class,  Insecta ; Order,  Co- 


CANTHARIS. 


277 


leoptera,  is  a native  of  the  south  of  Europe,  and  also  of  Germany 
and  Russia  ; and  it  has 

been  met  with  in  Eng-  Fig-  40. 

land.  In  the  summer  of 
1837,  according  to  Dr. 

Pereira,  it  was  abundant 
in  Essex,  and  Suffolk.  It 
is  found  on  species  of 
Oleaceae,  as  the  ash,  pri- 
vet, and  lilac ; and  of 

Caprifoliacese  — as  the  el-  camharides. 

der  and  lonicera. 

It  inhabits  the  earth  in  the  larva  state,  and  appears  in  the  form  of 
fly  in  May,  when  it  infests  the  trees  and  shrubs  in  such  numbers  in 
some  of  the  promenades  of  southern  Europe,  as  to  drive  away  the 
visiters.  The  flies  are  caught  either  in  the  morning  or  evening,  at 
which  time  they  are  less  active,  by  spreading  cloths  under  the  trees, 
which  are  strongly  shaken  or  beaten  with  long  poles.  The  collec- 
tors are  obliged  to  have  both  their  faces  and  hands  protected.  After 
they  have  fallen  off  they  are  killed  by  being  exposed  to  the  vapour 
of  vinegar,  hot  water,  spirit  of  wine,  or  oil  of  turpentine  ; or  by 
immersing  the  cloths  containing  them  in  hot  vinegar  and  water,  and 
then  drying  them. 

At  one  time,  Spain  supplied  Cantharides  largely,  whence  their 
name  Spanish  Flies  ; but  at  the  present  day,  they  are  imported  partly 
from  Messina,  and  partly  from  St.  Petersburg.  They  are  very  abun- 
dant in  the  southern  provinces  of  Russia.  The  Russian  flies  are  the 
largest  and  most  esteemed.  In  the  year  1839,  duty  was  paid  in 
England  on  16,376  pounds.  (Pereira). 

Dried  Spanish  Flies — as  met  with  in  the  shops  — are  from  six  to 
ten  lines  long,  and  about  a grain  and  a half  in  weight.  Their  odour 
is  peculiar  and  disagreeable  ; their  taste  acrid  and  burning.  They 
should  be  kept  perfectly  dry  by  means  of  well  stopped  bottles,  and 
as  they  are  subject  to  destruction  by  insects  — which  devour  the 
vesicating  portion  with  the  rest — it  may  be  well  to  sprinkle  them 
with  pyroligneous  acid,  or  with  a few  drops  of  strong  acetic  acid. 
This  last  has  been  found  an  excellent  preservative.  When  dried, 
they  can  be  reduced  to  powder,  which  has  a grayish-brown  appear- 
ance, with  numberless  shining  green  particles.  It  is  in  this  state 
that  they  are  most  liable  to  adulteration.  When  in  the  entire  state, 
their  goodness  is  appreciated  by  their  odour,  and  freedom  from 
mites  and  other  insects.  The  powder  is  sometimes  adulterated  with 
powdered  euphorbium,  especially  in  the  formation  of  the  plaster, 
and  Dr.  Pereira  affirms,  that  he  has  been  informed  by  persons  well 
acquainted  with  the  fact,  that  it  is  a common  practice,  amongst 
certain  druggists,  to  mix  one  pound  of  euphorhium  with  fourteen 
pounds  of  powdered  Spanish  Flies. 

Cantharides  have  been  often  analysed,  but  the  results  obtained  by 
VOL.  I. — 24 


278 


SPECIAL  DIURETICS. 


Robiqiiet  have  received  the  most  attention.  He  found  them  to  con- 
tain, 1.  A peculiar  principle  — cantharidin — procured  hy  concen- 
trating an  alcoholic  tincture  obtained  by  displacement,  and  setting  it 
aside,  so  that  the  cantharidin  may  crystallise  : the  blistering  property 
of  cantharides  is  evident  in  this.  2.  A green  fatty  oil,  soluble  in 
alcohol.  3.  A fatty  matter  insoluble  in  alcohol,  4.  A yellow  viscid 
substance,  analogous,  to  osmazome.  5.  A black  colouring  matter. 
6.  A yellow  colouring  matter.  7.  Free  acetic  and  uric  acids;  and 
8.  Phosphate  of  lime,  and  phosphate  of  magnesia.  The  main  active 
constituent  appears  to  be  the  cantharidin,  and  it  would  seem  to  exist 
only  in  the  trunk  and  soft  parts  of  the  body,  as  the  other  parts  have 
been  found  inert  or  nearly  so  ; yet  there  would  seem  to  be  some  volatile 
odorous  matter  exhaled  from  the  insects,  as  irritation  is  produced  by 
sitting  under  trees  on  which  they  are  found,  or  by  breathing  the 
vapour  from  a decoction  of  them.  The  virtues  of  cantharides  are 
yielded  to  boiling  water ; but  more  readily  to  acetic  acid,  alcohol, 
pure  and  dilute,  — ether,  and  the  fixed  and  volatile  oils. 

Of  the  effects  of  Cantharides,  when  applied  to  the  cutaneous 
surface,  mention  will  be  made  in  another  place.  Taken  internally, 
they  are  a most  violent  acrid  poison,  and  have  therefore  to  be  pre- 
scribed with  great  caution  as  a medicinal  agent.  When  given  in 
too  large  a dose,  their  effects  on  the  genito-urinary  system  are  ex- 
hibited by  the  ordinary  signs  of  nephritis  and  cystitis ; and,  by  the 
extension  of  the  irritation  through  contiguous  sympathy,  priapism, 
and  sometimes  satyriasis  are  induced  in  the  male ; and  irritation  of 
the  sexual  organs,  and  occasionally  abortion  in  the  female.  When 
given  to  this  extent,  the  renal  secretion  may  be  diminished  or  arrested. 
In  a smaller  dose,  however,  they  excite  the  kidneys  to  increased 
action  ; but  although  always  classed  amongst  diuretics,  they  are  un- 
certain in  their  operation,  and  are  really  more  beneficial  as  revellents, 
through  the  nephritic  irritation  which  they  induce ; accordingly,  they 
are  less  prescribed  in  diseases,  which,  like  dropsy,  require  an 
augmentation  of  the  secretory  action  of  the  kidneys,  than  in  neuralgic 
affections,  which,  like  lumbago  and  sciatica,  are  best  relieved  by 
revellents.  It  can  likewise  be  understood,  that,  by  virtue  of  those 
same  excitant  properties,  they  may  be  beneficial  in  paralysis  of  the 
bladder,  and  in  cases  of  atony  of  the  genito-urinary  organs  in  general. 
Should  cystitis  be  induced  by  them,  it  must  be  met  by  blood-letting, 
and  by  the  free  use  of  demulcent  drinks. 

The  dose  of  the  powdered  flies  is  one  or  two  grains  made  into  a 
pill  with  conserve  of  roses,  or  extract  of  taraxacum,  which  may  be 
repeated  twice  a day.  The  tincture,  however,  is  more  frequently 
employed. 

TIKCTFRA  CAKTHAR'IDIS,  TINCThRE  OF  SPANISH  FLIES.  {Cantharid. 
Contus.  jj  ; Alcohol,  dilut.  Oij.  It  may  be  prepared  by  simple  mace- 
ration, or  by  displacement.)  The  dose  is  ^x  to  f.  repeated 
three  or  four  times  a day  in  some  demulcent  fluid,  as  barley  water 
or  flaxseed  tea. 


TARAXACUM. 


279 


The  external  application  of  cantharides  will  fall  under  consideration 
elsewhere. 


13.  CAN^THARIS  VITTa'tA. POTa'tO  FLIES. 

Can'tharis  Vitta'ta,  Lytta  Vitta'ta  or  Pota'to  Fly,  is  somewhat 
smaller  than  Cantharis  Vesicaforia,  — its  length  being  about  six 
lines.  The  head  is  of  a light  red  colour,  with  dark  spots  on  the  top ; 
the  feelers  are  black ; the  elytra  or  wing-cases  black,  with  a yellow, 
longitudinal  stripe  in  the  centre,  and  a yellow  margin  ; the  thorax  is 
black,  with  three  yellow  lines ; and  the  abdomen  and  legs,  which 
are  of  the  same  colour,  are  covered  with  an  ash-coloured  down. 
(Wood  & Bache.)  The  flies  appear  — as  their  name  imports  — on 
the  potato  plant,  and  are  first  observed  about  the  end  of  July  or  the 
the  beginning  of  August.  They  are  found  in  the  morning  and 
evening ; and  are  collected  by  shaking  them  from  the  plant  into  hot 
water ; after  which  they  are  carefully  dried  in  the  sun. 

Cantharis  vittata  is  a native  of  the  middle  and  southern  States.  It 
resembles  cantharis  vesicatoria  in  all  its  properties. 

Other  species  of  cantharis  are  found  in  the  United  States,  viz.  C. 
Ciner'ea,  a native  of  the  northern  and  middle  States  ; C.  Margi- 
na'ta  ; C.  Atra'ta,  common  in  the  northern  and  middle  States,  &c. 
&c.  ; but  C.  Vittata  is  the  only  one  that  is  officinal. 

• • 14.  TARAX^ACUM.  — DAN'DELION. 

Leon'todon  Tarax’acim,  Tarax’acum  Dens  Leo'nisor  Common  Dan- 
delion ; Sex. 

Syst.  Syngene- 
sia  Polygamia 
iEqualis  : Nat. 

Ord.  Compositse 
Cichoracese,  is 
indigenous  in 
meadows  and 
pastures  in  most 
parts  of  the 
globe,  flowering 
all  the  summer. 

The  root  is  the 
only  part  which 
is  officinal  in  the 
Pharmacopoeia 
of  the  United 
States.  When 

fresh,  it  is  tapering,  and  abounds  with  a milky  juice,  which  contains 
bitter  extractive,  caoutchouc,  resin,  gum,  sugar,  and  various  salts. 
It  yields  its  virtues  to  hot  water,  and  hence  the  decoction  is  officinal 
in  the  Edinburgh  and  Dublin  Pharmacopoeias  : the  extract  is  in  all 
of  the  British  Pharmacopoeias  as  well  as  in  that  of  the  United  States. 


Fig.  41. 


Leontodon  Taraxacum. 


280 


SPECIAL  DIURETICS. 


Taraxacum  is  generally  regarded  as  a diuretic  and  tonic  ; nay,  it 
has  even  been  supposed  to  be  in  addition,  “ aperient,  deobstruent 
[?]  and  alterative,”  but  how  it  produces  these  effects,  and  in  what 
cases,  we  have  yet  to  learn.  The  author  has  often  administered  it, 
and  the  results  of  all  his  trials  induce  him  to  consider,  that  its  reme- 
dial agency  is  extremely  restricted.  That  it  is  possessed  of  tonic 
powers  to  some  extent  can  no  more  be  doubted  of  it  than  of 
other  bitter  vegetables ; but  even  in  this  respect  it  is  far  inferior  to 
most  of  the  vegetable  tonics.  ‘‘  After  having  been  long  abandoned 
in  practice,”  observes  a recent  writer.  Dr.  Christison  — ‘‘  it  was  re- 
sumed not  many  years  ago  in  this  country,  (Great  Britain,)  and  be- 
came a fashionable  remedy,  especially^in  London,  as  a tonic  ape- 
rient and  alterative  in  dyspepsia,  and  as  a deobstruent,  and  promoter 
of  the  biliary  secretion  in  functional  as  well  as  organic  diseases  of 
the  liver.  It  seems  not  without  its  use  in  dyspepsia  and  functional 
biliary  derangements ; but  my  own  observation  of  its  effects  would 
lead  me  to  infer,  that  much  has  been  ascribed  to  the  extract  of  dan- 
delion in  these  and  other  affections,  which  must  have  been  owing  to 
collateral  remedies,  or  to  regimen  and  diet.” 

It  is  asserted  to  have  been  found  beneficial  in  cases  of  dropsy  de- 
pendent upon  hepatic  obstruction,  but  it  is  probable,  that  farther  ex- 
})erience  will  limit  more  and  more  the  range  of  its  employment,  and 
that  it  may  ultimately  be  discarded  altogether. 

It  may  be  given  in  the  form  of  Decoctum  Taraxaci,  Decoction  of 
Dandelion.  [Taraxac.  contus.  ^ij  ; Aquce  Oij  ; boil  to  a pint.)  Of 
this,  from  one  to  two  fluid  ounces  may  be  given  three  or  four  times 
a day.  It  may  be  associated  with  other  diuretics,  as  squill,  or  bitar- 
trate of  potassa. 

EXTRAC'TUM  TARAX'ACI,  EXTRACT  OP  DAN'DELION.  This  extract  is  made 
from  a decoction  of  the  fresh  root.  The  dose  is  twenty  or  thirty 
grains  two  or  three  times  a day.  The  author  rarely  prescribes  it  ex- 
cept as  an  excipient  for  certain  tonic  or  other  agents  that  require 
to  be  made  into  pills. 

Recently  a Cream  of  Taraxacum  has  been  proposed  by  Dr.  Collier, 
which  he  prepares  in  the  following  manner.  Cut  the  fresh  roots  of 
dandelion,  — freed  from  any  adherent  earthy  matter,  and  previously 
washed  and  scraped,  — into  transverse  slices.  Sprinkle  any  quan- 
tity of  these,  whilst  moist,  slightly  with  spirit  of  juniper,  and  ex- 
press them  in  a tincture  press.  The  dose  of  the  cream,  thus  ex- 
pressed, is  a table-spoonful,  or  more,  twice  or  thrice  a day,  which, 
according  to  Dr.  Collier,  will  probably  produce  two  or  more  bilious 
evacuations  in  the  day.  It  may  be  diluted,  and  given  in  the  form  of 
draught,  with  any  of  the  diuretic  waters  and  infusions,  or  with  a 
solution  of  cream  of  tartar. 

15.  O'LEUM  TEREBINTH'IN^.  — OIL  OF  TUR'PENTINE. 

The  characters  of  this  volatile  oil  are  pointed  out  under  Excitants. 


ERIGERON  CANADENSE. 


281 


In  a moderate  dose,  it  is  unquestionably  an  excitant  diuretic  ; yet 
its  properties  in  this  respect  are  by  no  means  marked,  and  much  of 
its  character  may  have  been  derived  from  the  fact,  that  its  use  — as 
well  as  that  of  the  terebinthinates  in  general  — gives  occasion  to 
a violet  odour  of  the  urine.  It  has  been  administered,  however, 
in  dropsy,  and  in  asthenic  cases  is  said  to  have  been  occasionally 
serviceable.  It  certainly  cannot  be  indicated  in  dropsy  of  the  ac- 
tive kind,  accompanied  with  vascular  excitement.  In  larger  doses 
— as  elsewhere  remarked  — it  is  a powerful  excitant  of  the  abdo- 
minal nervous  system  especially,  and  hence  has  been  given  in  cases 
of  tubercular  meningitis,  or  what  has  been  conceived  to  be  the  stage  of 
invasion  of  acute  hydrocephalus  ; but  in  such  case  its  diuretic  ope- 
ration was  not  looked  to.  In  cases  of  lumbago,  sciatica,  &c.,  its 
operation  is  rather  revellent  than  diuretic  ; — the  excitant  or  revel- 
lent  action  being  exerted  on  the  kidneys. 

It  may  be  given  in  the  dose  of  8 or  10  drops  three  times  a day, 
dropped  on  sugar,  mixed  with  molasses,  or  made  into  an  emulsion 
with  mucilage  or  yolk  of  egg. 

16.  Copa'iba,  and  17.  Cubebs  (see  Excitants)  act  much  .in  the 
same  manner  as  oil  of  turpentine.  They  are  never  given  in  dropsy 
as  diuretics  ; but  they  are  prescribed  where  it  is  necessary  to  exert  a 
revellent  or  excitant  action  on  the  kidneys.  Yet,  they  are  often 
classed  amongst  diureties. 


Besides  the  agents  already  prescribed,  the  Pharmacopoeia  of  the 
United  States  has  admitted  into  the  secondary  list  the  following  ex- 
citant diuretics. 

18.  Caro'ta,  Car'rotseed — the  fruit  of  Daucus  Caro'ta  ; Sex.  Syst. 
Pentandria  Digynia;  Nat.  Ord.  Umbelliferae— a common  plant, 
growing  wild  in  the  United  States,  and  flowering  in  June  and  July. 
The  properties  of  carrotseed  are  probably  dependent  upon  volatile 
oil,  and  are  readily  communicated  to  boiling  water. 

Carrotseed  are  not  much  used  by  the  physician ; but  are  fre- 
quently prescribed  as  a domestic  remedy  in  affections  of  the  urinary 
organs,  and  in  dropsy.  The  dose  of  the  bruised  seed  is  from  J^ss 
to  5J*.  They  are  more  commonly  given  in  infusion.  (Carot.  ; 
Aquce  hullient.  Oj.  to  be  taken  during  the  day.) 

19.  Delphin'ium,  Larkspur^  — the  root  of  Delphin'ium  Consol'ida  ; 
Sex.  Syst.  Polyandria  Trigynia  ; Nat.  Ord.  Ranunculaceae — a 
species  introduced  from  Europe,  and  now  naturalised ; flowering 
in  June  and  July.  The  flowers,  seeds  and  root  are  all  said  to  be 
diuretic  ; but  the  last  is  the  only  part  that  is  officinal.  It  is  little  if 
at  all  used. 

20.  Erig"eron  Canaden'se  Can'ada  Fleahane ; Sex.  Syst.  Syn- 
genesia  Superflua ; Nat.  Ord.  Compositae  Corymbiferae  — an  indi^ 

24'^ 


282 


SPECmL  DIURETICS. 


geiious  plant,  common  in  the  northern  and  middle  States  ; flower- 
ing in  July  and  August. 
The  whole  plant  is  officinal. 
Its  main  constituents  are  tan- 
nic, and  gallic  acids,  bitter  ex- 
tractive, and  volatile  oil.  It 
is,  therefore,  astringent,  tonic 
and,  it  is  affirmed,  diuretic  ; 
and  has  been  given  in  dropsy 
and  also  in  chronic  diarrhoea 
and  dysentery  ; either  in  pow- 
der, the  dose  of  which  is  :^ss 
to  5j  ; or  in  infusion.  {Eri- 
ger.  Canadens.  §i  ; AqucB  hul- 
lient.  Oj.  Dose  f.  5iss  to 

f- 

21  & 22.  Erig"eron  He- 
terophyl'lum,  Various-leaved 
Fleahane^  and  E.  Philadel'phi- 
cuM,  Philadelphia  Fleahane ; 
both  of  which  are  called  Sca- 
bious— are  found  in  various 
parts  of  the  United  States,  and 
are  used  as  diuretics  in  dropsy. 
They  are  given  in  infusion  or 
decoction.  (Eriger,  ; Aquae 
bullient.  Oj.  Dose  f.  ^ij  to 
giv,  every  three  or  four 
hours.) 

23.  Petroseli'num,  Pa?'S- 
ley  — the  root  of  A'pium  Pe- 
troseli'num ; Sex.  Syst.  Pen- 
tandria  Digynia.  ^ Nat.  Ord. 
Umbellifer2e  — a native  of 
southern  Europe,  but  culti- 
vated in  gardens  every  where. 
It  contains  an  essential  oil, 
which  is  said  to  communicate 
to  it  diuretic  virtues.  It  is  also  affirmed  to  be  aperient.  The  strong  in- 
fusion has  been  advised  in  dropsical  affections,  and  in  diseases  of  the 
urinary  organs  in  which  a diuretic  is  considered  to  be  indicated  ; 
but  it  is  hardly  ever  used,  and  is  not  much  worthy  of  the  attention 
of  the  practitioner. 


II.  Sedative  Diuretics. 

24.  DTGITA'Ub\  — FOXGLOVE. 

Digiia'lis  purpidrea,  or  Purqyle  Foxglove  ; Sex.  Svst.  Didynamia 


DIGITALIS. 


283 


Angiospermia ; Nat.  Ord,  Scrophulariacese,  is  an  herbaceous  bien- 
nial plant,  growing  wild  in  most  of  the  temperate  countries  of  Eu- 
rope, where  it  begins  to  flower  in  June,  and  ripens  its  seed  in  August 
and  September.  In  the  United  States,  it  is  cultivated  both  for  orna- 
ment, and  medicinal  purposes.  The  leaves  are  alone  officinal  in 
the  Pharmacopoeia  of  the  United  States.  The  London  Pharmaco- 
poeia admits  also  the  seeds. 

Doubts  have  existed,  in  the  minds  of  many  observers,  in  regard 
to  the  equal  activity  of  the  cultivated  and  the  wild  specimens, 
and,  in  the  doubt,  the  wild  or  native  plants  have  been  generally  pre- 
ferred. 

The  leaves  are  usually  gathered,  as  first  advised  by  Withering, 
in  June  or  July,  when  the  plant  is  coming  into  flower,  or  soon  after- 
wards. It  has  been  considered,  however,  unnecessary  to  restrict 
the  gathering  of  them  to  this  period,  as  their  bitterness,  which  may 
perhaps  be  some  measure  of  their  activity,  is  very  intense  both  in 
February  and  September,  and  their  extract  is  highly  energetic  as 
a poison  in  the  middle  of  April,  before  any  appearance  of  the  flow- 
ering stem.  They  should  be  dried  very  carefully,  and  be  pre- 
served from  light  and  air.  The  midrib  and  footstalk — being  pos- 
sessed of  little  or  no  efficacy  — may  be  removed  before  drying.  In 
this  state,  they  are  of  a dull  green  colour,  faint  odour,  and  a bitter 
nauseous  taste. 

As  met  with  in  the  shops  of  this  country,  digitalis  is  often  in  com- 
pressed masses,  like  the  dried  herbs  in  general  prepared  by  the 
Shakers  of  Lebanon ; and  these  cakes  are  not  unfrequently  found  to 
be  more  or  less  mouldy ; hence  this  mode  of  preparation  has  been 
properly  objected  to.  (Wood  and  Bache.) 

Digitalis  readily  yields  its  virtues  to  water  and  alcohol.  It  has 
been  repeatedly  analysed,  but  no  important  pharmacological  infor- 
mation has  been  obtained.  At  one  time,  its  active  principle  was 
supposed  to  have  been  discovered,  and  was  termed  Digitalin ; but 
the  discovery  was  not  confirmed,  — the  digitalin  being  esteemed  a 
mixture  of  other  matters.  Recently,  however,  MM.  Homolle  and 
Quevenne  have  succeeded  in  separating  it.  When  pure,  it  pre- 
sents itself  in  the  form  of  a white,  inodorous  powder,  of  an  exces- 
sively bitter  taste,  which  is  especially  experienced  in  the  fauces. 
When  disseminated  in  very  small  particles  in  the  air  it  causes  violent 
sneezing.  It  is  scarcely  soluble  in  cold  water ; rather  more  so  in 
boiling  water ; and  is  soluble  in  all  proportions  in  dilute  and  con- 
centrated alcohol.  Pure  ether  only  dissolves  traces  of  it ; but  the 
slightest  addition  of  alcohol  considerably  increases  its  solvent  power. 

An  empyreumatic  oil  has  been  obtained  from  the  product  of  de- 
structive distillation,  which  is  composed,  in  part,  of  a highly  narcotic 
crystalline  principle.  When  given  to  a rabbit,  it  caused  paralysis 
of  the  hind  legs,  convulsions,  laborious  and  rapid  breathing,  and 
accelerated  action  of  the  heart. 

The  effects  of  digitalis  on  the  nervous  system,  and,  through  it, 


284 


SPECIAL  DIURETICS. 


on  many  of  the  functions,  will  be  described  under  the  head  of 
Narcotics.  In  this  place,  its  action  on  the  kidneys  alone  falls  un- 
der consideration.  This  it  exerts  both  in  disease  and  health,  and 
hence  it  is  properly  a direct  diuretic. 

On  inspecting  the  testimony  of  various  observers  in  regard  to  the 
dropsical  cases,  in  w'hich  the  diuretic  virtues  of  the  digitalis  have 
been  had  recourse  to,  much  that  appears  to  be  irrational  is  percepti- 
ble. It  is  well  known  to  be  a powerful  sedative,  and  as  such  is 
employed,  whenever  the  force  of  the  circulation  has  to  be  controlled, 
as  in  hypertrophy  of  the  heart,  and  in  great  vascular  excitement,  no 
matter  how  produced  ; hence  it  would  seem  to  be  especially  adapted 
for  the  sthenic  forms  of  dropsy  ; yet  we  are  told  by  Withering  — 
and  the  remark  has  been  handed  down  from  one  therapeutical  wri- 
ter to  another  — that  it  seldom  succeeds  in  men  of  great  na- 
tural strength,  of  tense  fibre,  of  warm  skin,  of  florid  complex- 
ion, or  in  those  with  a tight  and  cordy  pulse.”  On  the  con- 
trary” — it  is  affirmed  — if  the  pulse  be  feeble  or  intermitting,  the 
countenance  pale,  the  lips  livid,  the  skin  cold,  the  swollen  belly 
soft  and  fluctuating,  or  the  anasarcous  limbs  readily  pitting  under 
the  pressure  of  the  finger,  we  may  expect  the  diuretic  effects  to  fol- 
low in  a kindly  manner.”  Yet,  if  W”e  know  any  thing  rational  con- 
cerning the  modus  o'perandi  of  digitalis,  it  ought  to  be  adapted  for 
the  first  set  of  cases  rather  than  for  the  last.  Doubtless,  it  may  be 
itself  insufficient  to  reduce  the  sthenic  condition  of  the  system,  and 
may  require  the  use  of  an  active  antiphlogistic  treatment,  premised 
or  combined  with  it  ; yet  in  the  sthenic  class  of  cases,  its  utility  has 
been  most  manifested  ; and  such  is  the  result  of  the  author’s  expe- 
rience. It  certainly  has  not  been  found  by  him,  as  by  Dr.  Christi- 
son,  “ most  serviceable  in  dropsies  associated  with  an  enfeebled 
state  of  the  constitution.”  The  writer  just  cited  affirms,  moreover, 
that  ‘‘  dropsies  depending  on  diseased  heart,  are  more  under  its  in- 
fluence than  any  other  kind,  and  next  those  connected  with  diseased 
kidneys  ;”  but  this  cannot  be  regarded  as  established.  No  gene- 
ral assertion  of  the  kind  is,  indeed,  admissible,  inasmuch  as  every 
thing  will  depend  upon  the  degree  of  cardiac  mischief,  that  gives 
occasion  to  the  dropsy.  Too  often,  in  such  cases,  all  remedies  fail ; 
and,  in  the  very  nature  of  the  circumstances,  they  can  *only  act  as 
palliatives. 

As  a diuretic,  digitalis  should  be  given  in  small  doses  — for  ex- 
ample, one  grain  of  the  powder  three  times  a day — until  the  effect  is 
induced.  In  all  cases,  however,  the  patient  should  be  watched,  and 
if  great  depression  of  the  powers  of  the  circulation,  giddiness,  in- 
somnia, nausea  and  vomiting,  or  convulsions  should  supervene,  its 
use  ought  to  be  suspended.  It  has  been  the  opinion  of  some  prac- 
titioners, that  its  effects  are  cumulative^  and  that  they  may  explode 
— as  it  were — some  time  after  it  has  been  discontinued.  This  may 
be  borne  in  mind.  At  the  same  time,  it  is  proper  to  add,  that  al- 
though the  author  has  prescribed  it  largely,  in  hospital  and  in  pri- 


DIGITALIS. 


285 


vate  practice,  he  has  never  witnessed  this  cumulation,  which  has 
been  the  source  of  so  much  alarm  to  others.  It  would  seem,  how- 
ever, from  the  results  of  recent  experiments  on  digitalin  by  MM. 
Bouchardat  and  Sandras,  that  its  toxical  power  has  to  be  feared, 
notwithstanding  the  prescriber  may  have  felt  secure  for  several  days. 

Digitalis  is  not  often,  perhaps,  given  as  a diuretic  alone.  It  is 
either  combined  with  squill,  bitartrate  of  potassa,  or  with  the  mild 
chloride  of  mercury  — with  the  latter,  for  the  reasons  already  ex- 
pressed, (p.  269).  The  Edinburgh  College  has  a Pilula  Digitalis 
ET  SciLL^,  which  is  a combination  of  two  of  the  diuretics  men- 
tioned. [Digital.^  ScillcB  Confect,  aromat.  p.  ii.  Beaten 

into  a proper  mass  with  confection  of  red  roses,  and  the  mass  divided 
into  four-grain  pills.) 

The  Infusion  and  the  Tincture  are  officinal  in  the  Pharniaco- 
poeia  of  the  United  States ; and  the  latter  is  perhaps  most  frequently 
employed. 

INFU'SllM  DIGITATIS,  INFU'SION  OF  FOXGLOVE.  {Digitalis  5!;  Aquce 
bullient.  Oss ; Tinct.  cinnam.  f.  §j.)  The  tincture  of  cinnamon  is 
added  to  prevent  the  digitalis  from  affecting  the  stomach.  The  in- 
fusion is  a good  preparation  ; by  some,  indeed,  believed  to  be  the 
most  effective  of  any.  Its  dose  is  f.  §ss  to  f.  §j,  repeated  every 
six  hours  or  oftener.  The  recent  observations  of  Dr.  Munk  on  a 
very  large  number  of  cases  induce  him  to  give  the  preference  to  the 
infusion  as  a diuretic  over  every  other  preparation  of  the  drug. 

TINCTU'RA  DIGITA'LIS,  TINC  TURE  OF  FOXGLOVE.  {Digitalis  ^iv;  Alcohol, 
dilut.  Oij  ; — made  by  maceration,  or  by  displacement.)  The  usual 
dose  of  this  tincture  is  ten  drops,  repeated  three  times  a day,  and 
cautiously  increased  where  considered  advisable.  This  quantity  the 
author  has  generally  found  sufficient  to  induce  'not  only  the  diuretic 
but  the  sedative  effects  of  the  drug.  Others,  however,  fix  the  usual 
dose  at  ten  minims  repeated  every  six  hours,  and  Dr.  Pereira  states, 
that  he  commonly  begins  with  rrixx.  The  largest  dose  he  has  em- 
ployed is  f.  5j*  It  has,  he  states,  been  given  to  the  extent  of  one 
ounce  ! The  author  has  known  some  cases  of  protracted  and  severe 
disease  in  which  very  large  doses  have  been  administered  with  im- 
punity ; but  these  cases  of  resistance  must  be  considered  as  excep- 
tions rather  than  as  forming  the  rule.  They  may,  also,  be  occa- 
sionally explained  by  inactivity  in  the  preparation.  None  but  well- 
prepared  and  well-preserved  leaves  should  be  used  in  the  formation 
of  the  tincture  ; and  a great  superiority  has  been  noticed  in  that 
made  from  carefully  preserved  leaves  imported  from  England.  — 
(Wood  & Bache). 

The  Germans  have  a Tinctura  Digitalis  ^therea,  made  by 
macerating  digitalis  in  sulphuric  ether  in  place  of  dilute  alcohol.  Sir 
George  Lefevre  says,  ‘^that  this  is  a very  useful  preparation,  and  a 
convenient  mode  of  administering  the  remedy.  The  nauseating  proper- 
ties of  the  digitalis,  he  thinks,  are  counteracted  by  the  stimulant  power 


286 


SPECIAL  DIURETICS. 


of  the  menstruum,”  and  in  cases  of  serous  effusion,  where  it  is  desira- 
ble to  increase  the  action  of  the  absorbents,  and  to  determine  to  the 
kidneys,  this  preparation  seems  to  combine  these  advantages  with- 
out producing  the  nausea  and  exhaustion,  which  frequently  accom- 
pany the  use  of  the  simple  tincture. 

Digitalin,  described  above,  when  exhibited  in  a very  serious  case 
of  anasarca  complicated  with  pericarditis  and  hsematuria,  caused,  ac- 
cording to  M.  Bouchardat,  an  enormous  and  immoderate  diuresis, 
accompanied  by  greatly  diminished  frequency  of  pulse,  which,  in  48 
hours,  fell  from  120  to  54  in  the  minute.  The  absorption  of  the 
dropsical  fluid  was  effected  very  rapidly,  and  the  treatment  proved 
successful.  In  two  cases  of  pleurisy,  the  diuretic  action  was  evi- 
dent, and  the  absorption  of  the  effusion  seemed  to  be  hastened. 

The  dose  and  mode  of  administering  this  energetic  agent  require 
the  greatest  circumspection.  M.M.  Homolle  and  Quevenne,  from 
comparative  essays,  have  found,  that  four  milligrammes  (gr.  .0616) 
of  digitalin  correspond  in  energy  of  action  to  about  eight  French 
grains  (gr.  6.56)  of  digitalis.  , 

25.  COL'CHICI  RADIX.  — COL'CHICUM  ROOT;  AND  COL'CHICI 
SEMEN.  — COL'CHICUM  SEED. 

The  general  properties  of  Colchicum  are  described  under  the  head 
of  Sedatives.  In  its  effects  it  is  said  by  some  to  resemble  digitalis 
in  one  thing,  — that  it  renders  the  pulse  less  frequent.  Others,  how- 
ever, think,  that  it  agrees  more  with  the  squill  in  certain  respects, 
and  they  would,  consequently,  class  it  rather  amongst  the  Excitant 
Diuretics. 

The  root,  and  the  seed  have  been  given  as  diuretics  in  dropsy, 
both  formerly  and  in  more  modern  times.  In  such  cases  it  is  well 
to  push  the  remedy  until  it  affects  the  bowels  as  well  as  the  kidneys. 

The  dose  of  the  dried  root  and  of  the  seeds  is  the  same,  — from 
two  to  eight  grains. 

ACE'TUl  COL'CHICI,  VIN'EGAR  OF  COL'CHICUM.  {Colchic.  rad.  contus.  §ij ; 
Acet.  destillat.  Oij  ; Alcohol,  f.  ; prepared  either  by  maceration  or 
displacement.)  Vinegar  of  colchicum  has  been  a favourite  diuretic 
in  dropsy.  Its  dose  is  from  f.  5ss  to  f. 

The  other  preparations  of  colchicum  are  given  under  Sedatives. 

26.  VERA'TRIA. 

This  active  principle,  whose  properties  are  described  under  Seda- 
tives, is  also  possessed  of  diuretic  powers  ; partly,  perhaps,  as  sug- 
gested by  Dr.  Turnbull,  owing  to  the  sedative  agency,  which  it  has 
been  found  to  exert  on  the  heart’s  action,  even  when  applied  exter- 
nally. The  testimony  of  one  observer  in  its  favour  is  so  strong  as  to 
savour  of  undue  enthusiasm  : — Unadulterated  veratria,”  says 
Ebers,  ‘‘  acts  often  on  the  urinary  secretion  with  magical  powers. 


ANTILITHICS. 


287 


and  it  may  seem  fabulous,  when  I state,  that  friction  with  a very 
weak  ointment  of  veratria  two  or  three  times  in  the  twenty-four 
hours  on  the  inner  part  of  the  thigh,  or  the  back,  epigastric  region 
or  around  the  navel,  has  excited  such  a copious  secretion  of  urine, 
that  the  patients,  under  its  long  continuance,  began  to  feel  weak, 
and  the  anasarca,  and  even  the  dropsical  accumulation  in  the  abdo- 
men, in  a short  time  almost  disappeared ; — circumstances,  which  indi- 
cate the  caution  that  ought  to  be  observed  in  apportioning  the  dose, 
w^hen  we  are  satisfied  of  the  goodness  of  the  article.” 

The  experience  of  Ebers  has  been  confirmed  by  that  of  others  ; 
but  some,  as  Messrs.  Bardsley  and  Spath,  have  found  it  of  no  avail, 
and  it  is  now  scarcely  employed. 

Veratria  maybe  given  in  Tincture,  (Fem^r.  gr.  iv ; Alcohol. 
5j.  Dose,  gtt.  X.  to  XXV.  in  water);  or  rubbed  on  the  skin  in  Oint- 
ment, ( gr.  V. — XX.;  Adipis,  5j.  A piece,  the  size  of  a 
hazelnut,  to  be  rubbed  on  the  skin  for  five  or  ten  minutes,  night  and 
morning.) 


IV.  ANTILITH'ICS. 

Definition  of  antilithics,  and  of  lithonthryptics  — Calculous  diathesis  ~~  Lithic  and 
phosphatic  diatheses  — Different  varieties  of  calculus  — Therapeutical  application  of 
antilithics  to  those  varieties  — Lithonthryptics  — Special  antilithics. 

The  class  of  antilithics  comprises  agents,  that  counteract  the  ten- 
dency to  the  formation  of  calculous  concretions  in  the  urinary  organs. 
Under  the  same  head  may  be  investigated  the  modus  operaridi  of 
lithonthryptics,  or  agents  which  are  capable  of  dissolving  such  con- 
cretions ; but  as  our  means  for  the  latter  purpose  are  extremely 
limited,  and  rarely  available  or  successful,  attention  will  be  mainly 
directed  to  the  class  of  antilithics. 

1.  Antilithics, 

Antilithics  are  amongst  the  most  interesting  of  the  classes  of 
therapeutical  agents  ; for  what  disorder  is  there,  that  excites  more 
mental  uneasiness  and  apprehension  than  any  form  of  calculous  de- 
position. The  pain  attendant  upon  the  presence  of  stone  in  the 
bladder  ; the  inutility  of  remedial  agents,  when  once  it  has  formed, 
excepting  so  far  as  concerns  the  prevention  of  its  increase,  and  the 
serious  operations  demanded  for  its  removal,—  are  sufficient  grounds 
for  the  anxiety,  which  is  felt  by  every  one,  when  he  has  reason  to 
believe  that  he  is  labouring  under  a calculous  diathesis. 

That  such  a diathesis  may  be  present,  we  have  the  most  unques- 
tionable evidence,  and  when  it  exists  the  greatest  difficulty  occurs 
in  removing  the  tendency  to  deposition.  Often,  it  appears  to  be 
owing  to  an  organisation  derived  from  progenitors;  when — like 
every  other  hereditary  tendency — it  is  almost  irremediable,  although 
due  attention  to  diet  and  regimen  may  accomplish  much. 


288  • 


ANTILITPIICS. 


That  -this  diathesis  is  connected  with  a morbid  condition  of  the 
secerning  function  of  the  kidney  is  clear.  We  find  the  organ  form- 
ing gthat  which  it  ought  not,  and  the  urine  depositing  that  which 
it  ought  not  ; but  this  vice  of  secretion  is  clearly  connected  with  a 
morbid  condition  in  other  organs.  The  whole  system  of  nutrition 
is  often  implicated  ; the  gastric  functions  are  imperfectly  performed  ; 
the  nutrition  of  the  body  is  impaired,  and  in  the  phosphatic  dia- 
thesis especially  — when  largely  developed  — every  symptom  is 
present,  which  is  considered  to  indicate  cachexia. 

The  ordinary  urinary  calculi  arise  from  the  deposition  of  sub- 
stances, which  are  contained  in  that  fluid  in  a state  of  health,  but 
are  rendered  insoluble,  owing  to  various  circumstances  ; but  some 
calculi — as  the  oxalates  — do  not  exist  in  the  urine  in  health,  and 
must,  consequently,  be  formed  by  chemico-vital  influence  in  the 
kidney.  It  becomes,  however,  an  interesting  topic  of  inquiry  — 
whether  the  mischief  be,  in  these  cases,  seated  altogether  in  the 
kidney,  or  whether  it  may  not  be,  in  part,  owing  to  the  blood  being 
modified  in  consequence  of  general  faulty  nutrition,  so  that  it  con- 
tains matters  which  do  not  exist  in  it  in  the  normal  state.  In 
reply  to  this,  it  has  been  urged,  that  such  matters  ought  to  be  de- 
tected by  the  chemical  analyst ; but  this  objection  is  invalid,  for  the 
reasons  elsewhere  stated  — that  it  is  by  no  means  easy  to  detect 
even  an  inorganic  substance,  — of  whose  presence  we  may,  not- 
withstanding, be  certain,  — when  it  becomes  mixed  with  compounds 
of  organisation:  it  may  be  so  masked  by  the  latter,  that  its  presence 
cannot  be  indicated  by  the  ordinary — or,  indeed,  by  any  — re- 
agents. On  the  other  hand,  there  is  strong  reason  for  presuming, 
that  the  disease  is  not  altogether  seated  in  the  kidney,  when  w^e 
reflect  on  the  great  similarity  between  the  calculous  and  the  gouty 
diathesis.  It  is  a common  remark,  founded  on  just  observation, 
that  of  the  children  of  gouty  parents  some  may  be  liable  to  gout, 
and  others  to  calculus,  — the  males,  who  are  exposed  to  indulgence 
in  the  ordinary  exciting  causes,  being  more  subject  to  the  former 
disease  ; — the  females  to  the  latter.  Both  diseases  are  accom- 
panied by  more  or  less  gastric  and  intestinal  derangement,  and  by 
modified  nutrition  in  general ; and  another  striking  poii:t  of  simi- 
larity is  the  presence  of  urate  of  soda  in  the  concretions,  which  are 
met  with  in  the  joints  of  those  who  have  suffered  from  repeated 
arthritic  attacks.  Lithic  or  uric  acid  was  at  one  time  supposed  to 
exist  in  the  urine  only,  and  it  is  the  constituent  of  one  form  of 
urinary  calculi ; yet,  in  gouty  cases,  w*e  have  it  separated  from  the 
blood  by  other  organs  than  the  kidneys,  and  are,  consequently,  com- 
pelled to  infer,  that  in  calculous  cases  the  disease  may  not  merely 
consist  in  faulty  secretion  by  those  organs,  but  that  the  blood  may 
contain  elements,  which  can  be  combined  in  other  secreting  organs  ; 
and  they  clearly  are  so,  in  the  case  of  the  gouty  concretions  in 
question. 

In  the  treatment  of  calculous  cases,  therefore,  it  becomes  a matter 


ANTILITHICS. 


289 


of  moment,  that  our  attention  should  not  be  directed  exclusively 
to  the  condition  of  the  kidneys,  but  that  it  should  be  extended  to 
the  state  of  the  whole  system  ; and  experience  exhibits  the  coi«;ect- 
ness  of  this  doctrine. 

The  results  of  the  chemical  researches  of  Liebig  led  him  to 
infer,  that  when  uric  acid  is  subjected  to  the  action  of  oxygen 
under  certain  conditions,  it  undergoes  a metamorphosis,  whence, 
amongst  other  matters,  oxalic  acid  may  result.  “ Calculi,  contain- 
ing uric  acid,  or  oxalic  acid,”  he  says,  “ are  never  found  in  phthisi- 
cal patients,”  — a remark,  however,  which  requires  fresh  observa- 
tions before  it  can  be  considered  established  ; and  he  adds  : — “it  is 
a common  occurrence  in  France,  among  patients  suffering  from  cal- 
culous complaints,  that  when  they  go  to  the  country,  where  they 
take  more  exercise,  the  compounds  of  uric  acid,  which  were  de- 
posited in  the  bladder  during  their  residence  in  town,  are  succeeded 
by  oxalates,  (mulberry  calculus,)  in  consequence  of  the  increased 
supply  of  oxygen.  With  a still  greater  supply  of  oxygen,  they 
would  have  yielded,  in  healthy  subjects,  only  the  last  product  of 
the  oxidation  of  uric  acid,  — namely,  carbonic  acid  and  urea.” 

The  two  chief  calculous  diatheses  are  — the  lithic  or  uric^  and 
the  pliosphatic.  The  former  is  attended  by  a state  of  the  urine, 
which  reddens  litmus  paper  ; by  yellow,  red,  or  lateritious,  or  pink 
depositions  of  lithate  of  ammonia  or  by  the  appearance  of  red 
gravely  which  consists  of  crystals  of  lithic  acid.  In  the  latter^  the 
urine  is  pale  ; at  times  alkaline  ; and  there  is  a deposition  of  white 
gravely  or  crystals  of  phosphate  of  magnesia  and  ammonia  ; or  the 
white  sediment  contains  the  mixed  phosphates  of  magnesia,  ammonia 
and  lime. 

At  times,  these  two  diatheses  do  not  alternate  in  the  same  indi- 
vidual, but  there  is  usually  a great  disposition  for  the  lithic  to 
change  into  the  phosphatic.  The  urine  becomes  pale  under  slight 
causes  of  general,  or  gastric  disorder  ; mixed  lithic  and  phosphatic 
deposits  occur,  or  an  iridescent  pellicle  of  triple  phosphate  forms 
upon  its  surface.  (Dr.  Marshall  Hall.)  At  length,  the  urine  becomes 
alkaline,  and  white  gravel  is  deposited.  The  phosphatic  diathesis 
is  now  confirmed. 

These  are  the  chief  diatheses,  but  others  may  be  enumerated. 
For  example,  the  crystals  of  the  triple  phosphate  are  apt  to  be 
changed  for  a pulverulent  deposit  of  that  phosphate,  mixed  with 
phosphate  of  lime.  This  mixture  constitutes  the  fusible  calculus^ 
and  into  it  all  the  other  forms  of  calculous  diathesis  have  a ten- 
dency to  pass.  Again,  a diathesis  exists,  in  which  the  mulberry 
calculus  or  that  which  consists  of  oxalate  of  lime  may  be  formed. 

From  different  data,  examined  by  .Dr.  Front,  it  appears  that  lithic 
acid  predominates  in  more  than  one-third  of  the  whole  number  of 
urinary  calculi  ; and  very  generally  it  forms  the  nucleus  even  of 
other  varieties.  It  would  seem,  consequently,  that  the  deposition  of 
lithic  acid  is  a primary  step  in  the  formation  of  urinary  calculi,  and 


290 


ANTILITHICS. 


and  that  the  phosphatic  and  oxalic  formations  are  the  result  of  a 
gradual  transition  from  the  lithic  to  the  phosphatic  or  oxalatic  dia- 
thesis. In  the  progress  of  this  transition,  the  lithic  acid  deposition 
is,  in  the  first  instance,  changed  into  one  of  lithate  of  ammonia, 
Avith  a loss  of  the  tinge  derived  from  the  colouring  matters  of  the 
urine.  After  some  time,  this  last  gives  place  to  a sediment,  which 
is  chiefly  composed  of  carbonate  and  phosphate  of  lime ; and  this 
is  ultimately  succeeded  by  a deposition  of  the  phosphates  of  lime 
and  magnesia,  in  combination  with  ammonia.  From  all  his  in- 
quiries on  the  interesting  subject  of  urinary  depositions.  Dr.  Prout 
conceives  himself  warranted  in  deducing  the  general  laio^  ‘‘  that 
in  urinary  calculi,  a decided  deposition  of  the  mixed  phosphates  is 
never  followed  by  other  depositions.” 

Any  unusual  formation  of  acid  in  the  stomach,  or  elsew^here,  may 
be  the  cause  why  lithic  acid  is  deposited  from  the  urine.  If  we  add 
acid  to  healthy  urine,  it  is  throwm  down  in  small  reddish  crystals. 
The  lithate  of  ammonia,  which  exists  in  the  urine,  is  decomposed  ; 
the  acid,  which  we  add,  lays  hold  of  the  base,  and  lithic  acid  is  de- 
posited. We  can  thus  understand,  that  a deposition  of  lithic  acid 
crystals  may  be  an  evidence-of  acid  dyspepsia.  In  this  last  affec- 
tion, again,  as  well  as  in  other  states  of  the  system,  there  may  be  an 
undue  formation  of  lithic  acid  or  of  lithate  of  ammonia,  — as  in 
those  labouring  under  the  lithic  acid  diathesis,  — and  calculus  of 
gravel  may  be  deposited  from  such  redundancy. 

Therapeutical  Application  of  Antilithics, 

The  remedies  belonging  to  the  class  of  antilithics,  after  what  has 
been  said,  will  be  sufficiently  apparent.  Whenever,  from  the  ap- 
pearances presented  by  the  urinary  deposits,  and  by  the  concomi- 
tant symptoms  of  lithiasis,  it  is  manifest,  that  lithic  acid  or  lithates 
are  separated  from  the  urine  in  undue  quantity,  remedies  of  the  alka- 
line class  should  be  employed  to  neutralise  any  predominant  acid, 
and,  along  with  these,  tonic  and  revulsive  means  for  improving  the 
general  health.  Dr.  Prout  has  shown,  that  when  the  lithic  acid  dia- 
thesis exists,  and  the  urine  is  constantly  acid,  high  coloured,  and 
concentrated,  repeated  doses  of  alkalies  not  only  render  the  urine 
alkaline,  but  keep  it  so  as  long  as  they  are  employed.  With  these 
views,  the  liquor  potass ce,  or  the  carbonates  of  potassa  and  soda  are 
administered  wdth  some  vegetable  tonic,  and  a thorough  change  of 
all  the  physical  and  moral  circumstances  surrounding  the  indivi- 
dual,— if  this  be  practicable,  — is  recommended.  Change  of  air, 
of  society,  and  scenery,  must,  indeed,  be  regarded  as  amongst  the 
most  important  agents,  not  only  in  the  lithic  acid — but  in  every  kind 
of  calculous — diathesis.  The  importance,  too,  of  keeping  up  a 
free  cutaneous  exhalation  is  obvious.  The  perspiration  is  acid,  and 
if  this  acid  be  not  exhaled,  its  retention  in  the  system  may  give  rise 
to  the  acid  predominance  of  which  mention  has  been  made.  On 


ANTILITHICS. 


291 


these  grounds  it  has  been  affirmed  by  Dr.  Wilson  Philip,  that  dys- 
pepsia tends  to  increase  the  deposition  of  lithic  acid,  and  to  lessen 
that  of  the  phosphates,  .both  by  producing  acidity  of  the  primse  viee, 
and  by  rendering  the  skin  inactive  ; and  that  indolence  has  the  same 
tendency,  both  by  inducing  dyspepsia,  and  by  lessening  the  activity 
of  the  skin,  in  proportion  as  it  impairs  the  vigour  of  the  consti- 
tution. 

Dr.  A.  T.  Thomson  asserts,  that  lithic  acid,  in  a healthy  condi- 
tion of  the  habit,  is  freely  thrown  off  by  the  cutaneous  exhalants, 
but  he  probably  has  not  sufficient  ground  for  the  assertion  ; nor  is 
it  necessary  to  suppose  the  exhaled  acid  to  be  the  lithic  — to  ac- 
count for  the  increased  deposition  of  the  lithic  acid  from  the  urine, 
in  the  cases  we  have  been  considering.  Any  acid  predominance 
may  induce  the  same  effect. 

It  was  affirmed  by  Mr.  A.  Ure,  that  hippuric  acid  is  found  in  the 
urine  after  benzoic  acid  has  been  taken  ; and  that  the  quantity  of 
lithic  acid  is  thereby  diminished.  Hence,  benzoic  acid  was  recom- 
mended by  him  in  cases  of  the  predominance  of  lithic  acid.  The 
observations  of  chemists  have  not,  however,  confirmed  this.  On  the 
contrary,  they  have  shown,  that  althpugh  the  benzoic  acid  appears  to 
be  converted  into  the  hippuric,  there  is  no  diminution  in  the  quan- 
tity of  the  lithic  acid.  Neither,  therefore,  in  the  lithic  acid  diathe- 
sis, nor  in  cases  of  the  formation  of  gout  stones  or  tophaceous  depo- 
sits,— the  chief  constituent  of  which  is  lithate  or  urate  of  soda, — 
can  the  administration  of  benzoic  acid  be  advantageous. 

A more  important  suggestion  has  been  made  by  Dr.  Golding  Bird, 
founded  on  the  remarkable  solvent  action  of  phosphate  of  soda  on 
uric  acid,  to  which  Liebig  has  directed  attention.  This  is  to  admi- 
nister the  salt  in  solution,  sufficiently  diluted,  — a scruple  to  half  a 
drachm,  for  example,  — in  any  vehicle,  as  broth  or  gruel.  In  two 
cases,  its  administration  appeared  to  Dr.  Bird  to  be  followed  by  ma- 
nifestly good  effects. 

The  causes  that  give  rise  to  the  deposition  of  the  phosphates  are 
of  different  character.  In  one  respect,  indeed,  they  are  antitheses 
to  each  other.  The  phosphates  in  healthy  urine  are  considered  by 
Berzelius  to  be  held  in  solution  by  free  phosphoric  and  lactic  acids  ; 
and,  if  any  thing  interferes  with  the  presence  of  these  acids  in  due 
quantity,  the  phosphates  are  deposited.  Prout  offers  another  ex- 
planation, which  is  more  simple  and  intelligible.  The  phosphates, 
he  says,  exist  in  the  urine  as  supersalts,  and  in  this  state  are  soluble; 
but,  if  any  thing  neutralises  the  redundant  acid,  so  as  to  reduce  the 
supersalt  to  a neutral  salt,  it  is  then  deposited  — the  neutral  phos- 
phate being  insoluble.  If  a few  drops  of  ammonia  be  added,  to 
healthy  urine,  the  phosphates  are  thrown  down,  and  the  cause  of 
this  deposition  is  differently  explained  by  Berzelius  and  by  Prout, 
according  to  their  particular  views;  — the  former  considering,  that 
the  ammonia  neutralises  the  free  phosphoric  and  lactic  acids ; and 
the  latter,  that  it  neutralises  the  excess  of  phosphoric  acid. 


292 


ANTILITHICS. 


The  general  symptoms  that  accompany  the  deposition  of  the  phos- 
phates are  often  very  distressing : both  the  physique  and  the  moral 
are  greatly  implicated.  Derangement  of  the  digestive  organs  is  a 
universal  concomitant,  succeeded  by  every  symptom  of  impaired  nu- 
trition. In  some  cases  in  which  the  bladder  has  lost  a portion  of  its 
muscular  power — as  in  disease  of  the  prostate,  in  affection  of  the 
spine,  and  in  the  aged,  — the  urine  is  retained  so  long  in  the  bladder, 
that  it  undergoes,  it  is  affirmed,  partial  decomposition  ; ammonia  is 
generated,  and  a deposition  of  the  ammoniaco-magnesian  phosphates 
takes  place. 

As  far  as  regards  the  use  of  chemical  rem.edies,  the  selection  for 
the  phosphatic  diathesis  is  obvious.  That  which  is  proper  for  the 
lithic  acid  diathesis  would  be  obviously  injurious  in  this  : accord- 
ingly, alkaline  remedies  have  to  be  avoided,  wffiilst  acids, — espe- 
cially mineral  acids,  — can  be  administered  wdth  great  advantage. 
They  may  not  only  pass  into  the  blood,  and  act  chemically  on 
that  fluid,  but  invigorate  the  digestive  apparatus  and  prevent  fresh 
deposition. 

In  cases  of  the  alternating  calculi^  the  treatment  has  necessarily 
to  be  varied,  according  to  the  character  of  the  deposition,  — acid 
or  alkaline  remedies  being  given  according  as  the  deposits  are 
at  the  time  phosphatic  or  lithic  acid  ; but  in  the  depositions  of 
oxalate  of  lime,  nothing  but  general  management  can  offer  any 
prospect  of  benefit.  There  is  no  chemical  antilithic  available  in 
these  cases.  All  that  can  be  done  in  this,  as  well  as  in  the  other 
forms  of  the  calculous  diathesis  — when  inveterate — is  to  incul- 
cate the  necessity  of  a thorough  change  of  the  physical  and  moral 
influences  surrounding  the  individual,  so  as  to  break  in  upon  the 
morbid  catenation  as  effectively  as  possible.  With  this  view,  tra- 
velling, air,  and  exercise  are  recommended,  wdth  all  their  revul- 
sive accompaniments  ; a w^ell  regulated  diet  and  regimen  ; atten- 
tion to  the  condition  of  the  bow^els,  and  everything  that  can  induce 
tone  in  the  economy  generally.  By  thus  modifying  the  whole 
system  of  nutrition,  the  calculous  diathesis  may  occasionally  be  got 
rid  of,  and  no  farther  signs  of  lithiasis  may  occur,  even  when  the 
individual  has  been  previously  strongly  disposed  to,  and  even  la- 
bouring under,  calculous  depositions. 

If  the  views  of  Liebig,  howmver,  be  correct,  (p.  289),  it  would 
seem,  that  in  the  case  of  lithic  depositions,  country  air  would  be 
injurious  to  residents  of  towns  by  converting  the  depositions  into 
those  of  the  oxalates: — but  this  matter  cannot  be  considered  set- 
tled. In  the  case  of  an  intelligent  medical  gentleman  from  the  in- 
terior of  Maryland,  who  consulted  the  author  some  time  ago,  phos- 
phatic depositions,  which  wmre  copious,  wmre  invariably  corrected 
by  the  free  use  of  saccharine  aliment. 

From  what  has  been  said,  we  can  fully  understand  the  agency  of 
tonics  and  astringents,  when  employed  as  antilithics.  But  it  has 
been  imagined,  that  certain  bitters,  which  combine  an  astringent 


LITHONTHRYPTICS. 


293 


principle,  are  peculiarly  adapted  for  such  cases;  this  principle 
being  presumed  to  enter  the  circulation,  and  to  act  more  particu- 
larly on  the  kidneys.  At  one  time,  indeed,  it  was  believed  — it 
need  hardly  be  said  most  erroneously  — that  such  vegetables  pos- 
sess chemical  or  solvent  properties.  Of  these  tonics — presumed  to 
operate  especially  as  antilithics  — the  leaves  of  diosma  crenata 
or  buchu;  the  root  of  pareira  brava,  and  the  leaves  of  uva  ursi 
have  been  mainly  recommended  ; but  the  author  is  not  prepared 
to  corroborate  the  once  prevalent,  but  now  generally  exploded,  idea, 
that  they  produce  other  results  besides  those  of  acting  as  astringent 
tonics  on  the  stomach,  and  of  improving  the  gastric  functions.  (See, 
on  the  nature  and  therapeutics  of  calculous  depositions,  the  author’s 
Practice  of  Medicine ^ 2d.  edit.  ii.  35,  Philad.  1844.) 

2.  Lithonthryp'tics, 

Thus  far  of  antilithics.  — Not  much  can  be  said  on  lithonthryptics 
or  solvents  of  calculi.  The  fact,  that  certain  mineral  waters,  as  the 
Vichy,  render  the  urine  alkaline,  could  scarcely  fail  to  suggest  their 
use  in  calculous  affections.  It  would  not  seem,  that  the  destruction 
of  calculi  by  that  water  is  effected  merely,  or  perhaps  chiefly,  in  the 
way  of  solution,  but  that  it  is  accomplished  in  a very  considerable  de- 
gree, especially  as  regards  those  of  the  triple  phosphates,  by  a kind 
of  disintegration  of  their  component  particles.  When  calculi  consist 
of  the  oxalate  or  phosphate  of  lime,  mingled  with  lithic  acid,  lithate 
of  ammonia,  or  the  triple  phosphate,  Vichy  water  is  said  to  attack 
and  disintegrate  them  rapidly.  These  waters  contain  a large  amount 
of  free  carbonic  acid,  and  nearly  a drachm  and  a half  of  bicarbonate 
of  soda  in  every  thousand  drachms  of  the  menstruum.  Besides  greatly 
increasing  the  quantity  of  the  urine,  they  exert  a decided  influence 
on  its  chemical  constitution  ; rendering  it  rapidly  neutral  if  pre- 
viously acid,  and  afterwards  alkaline  : from  being  high-coloured  it 
becomes  pale,  and  having  deposited  copiously,  it  becomes  limpid 
and  transparent.  The  experiments  of  several  • observers  are  cer- 
tainly encouraging,  and  suggest  the  importance  of  employing  the 
fictitious  waters  of  Vichy  where  the  natural  water  is  not  attainable. 
A formula  for  these  is  given  hereafter. 

Under  views  analogous  to  those  which  have  suggested  the  use  of 
the  alkaline  mineral  waters,  the  different  alkalies  and  alkaline  earths 
have  been  freely  administered  as  lithonthryptics.  It  is  not  proba- 
ble, however,  that  either  the  mineral  waters  in  question,  or  the 
alkalies,  can  generally  be  productive  of  benefit,  except  where  the  de- 
positions are  of  lithic  acid  or  the  lithates.  Still  the  fact  must  be 
borne  in  mind,  that  under  protracted  administration  of  such  waters, 
and  likewise  of  alkalies,  combined  with  the  free  use  of  diluents, 
calculi  of  other  kinds  have  experienced  disintegration.  Where,  too, 
these  agents  have  failed  to  dissolve  or  break  down  the  calculus,  they 
would  seem  to  have  greatly  mitigated  the  sufferings. 

Solvents  might  be  brought  into  immediate  contact  with  vesical 
25*  • 


294 


SPECIAL  ANTILITHICS. 


calculi  by  injection  ; and,  in  this  way,  alkalies  and  acids,  properly 
diluted,  have  been  employed.  Experiment  seems  to  have  shown, 
that  the  bladder  cannot  bear  the  presence  of  an  alkaline  solution 
sufficiently  strong  to  dissolve  a lithic  acid  calculus  ; but  it  would 
appear,  from  the  experiments  of  Sir  Benjamin  Brodie,  — that  loose 
concretions  of  the  phosphates  and  of  carbonate  of  lime  may  be 
acted  upon  by  a weak  solution  of  nitric  acid,  and  thus  be  gradually 
removed  from ‘the  bladder.  The  strength  of  the  solution,  employed 
by  Sir  Benjamin,  was  two  minims  and  a half  of  the  acid  to  a fluid 
ounce  of  distilled  water.  The  injection  was  sent  through  a cannula 
of  pure  gold.  It  occasioned  no  pain : the  patients  experienced  re- 
lief from  all  their  symptoms  ; the  quantity  of  adhesive  mucus  from 
the  lining  membrane’ of  the  bladder  was  diminished;  and  the  con- 
stant desire  to  empty  the  organ  much  abated.  By  testing  the  fluid 
that  had  been  used  wdth  a concentrated  solution  of  ammonia, 
phosphates  were  abundantly  precipitated,  — proving  that  the  calculi 
had  been  acted  upon. 

It  has  likewise  been  proposed  by  MM.  Prevost  and  Dumas  to  em- 
ploy galvanism  for  the  decomposition  of  calculi  in  the  bladder,  by 
passing  wires,  connected  with  the  poles  of  a galvanic  apparatus, 
into  that  viscus;  — but  the  proposition  has  received  little  attention. 
It  is  probable,  indeed,  that  any  decomposing  power,  which  could 
l)e  introduced  within  the  bladder  in  this  way,  would  be  apt  to  act 
upon  the  organ  itself,  and,  consequently,  not  be  devoid  of  danger. 
Cystitis  is  an  affection  to  be  apprehended,  indeed,  from  all  such 
agents. 

The  most  important  lithonthryptics  belong  to  the  domain  of  sur- 
gery, and  do  not,  therefore,  fall  under  consideration  in  this  work.  It 
seems  clear,  from  the  experience  of  practitioners  on  both  sides  of  the 
Atlantic,  that  there  are  cases  which  admit  of  urinary  calculi  being 
broken  down  in  the  bladder,  by  the  introduction  of  contunding  in- 
struments into  that  organ,  without  the  bladder  necessarily  suffering  ; 
and  the  operation  of  lithotrity,  or  lithothrypsy,  or  lithotresis,  must 
be  included  amongst  those  improvements,  for  which  the  philanthro- 
pist has  to  thank  the  genius  and  daring  of  the  modern  surgeon. 


SPECIAL  ANTILITHICS. 

1.  Jlcid  Antilithics. 

The  circumstances  under  which  acids  are  advisable  in  calculous 
depositions  have  been  pointed  out  already,  (p.  291.)  It  was  there 
shown,  that  they  are  eminently  serviceable  in  the  white  or  phospha- 
tic  depositions,  whilst  they  cannot  fail  to  augment  the  lithic  depo- 
sitions. 

Of  the  Min'eral  Acids,  either  the  sulpNuric,  the  muriat'icj  or 


ALKALIES. 


295 


nitric  may  be  prescribed  ; but  preference  is  usually  given  to  the  two 
first ; under  the  notion,  derived,  perhaps,  from  two  limited  experi- 
ence, that  the  last  disagrees  with  some  stomachs.  It  has  been  given, 
however,  in  large  doses  without  any  such  inconvenience  resulting. 
The  muriatic  acid  would  seem  to  be  the  most  congenial,  inasmuch 
as  it  is  one  of  the  acids  always  secreted  in  the  healthy  state  of  the 
stomach,  and,  therefore,  taken  at  times  with  impunity  even  by  those 
who  suffer  from  acidity.  In  neutral  or  alkaline  indigestion,  as  it  is 
termed,  which  is  occasionally  mistaken  for  acid  indigestion,  this  acid 
is  the  great  remedy. 

Muriatic  acid  may  be  given  in  the  dose  of  from  tt^x.  to  n\^xl.  in 
any  demulcent  drink;  and  during  its  administration  — indeed,  when- 
ever acids  of  any  kind  are  given  — the  urine  must  be  carefully  in- 
spected, and  if  any  signs  of  the  lithic  depositions  appear,  it  must  be 
discontinued. 

Both  in  the  case  of  children  and  of  adults,  the  careful  use  of  mi- 
neral acids  is  to  be  preferred  ; if  for  no  other  reason,  on  account  of 
the  uncertainty  that  exists  in  regard  to  the  modus  operandi  of  the 
Vegetable  Acids.  It  is  the  common  belief,  indeed,  that  the  latter 
are  decomposed,  and,  accordingly,  a difficulty  may  exist  in  knowing 
whether  they  may  be  beneficial  or  the  contrary.  Observation  ought 
to  settle  this  question,  but  it  has  not  yet  done  so.  Hence,  the  ordi- 
nary mineral  water  or  soda  water  of  the  shops  may  be  an  equivocal 
remedy  in  phosphatic  depositions,  so  far  as  regards  its  chemical 
agency  ; yet  it  may  be  of  essential  service  through  the  gentle  sti- 
mulus which  it  gives  to  the  digestive  function.  Of  late,  lactic  acid 
has  been  suggested  by  M.  Magendie,  owing  to  the  facility  with 
which  it  dissolves  phosphate  of  lime.  From  one  to  four  fluidrachms 
of  it  may  be  dissolved  in  a quart  of  water,  sweetened  with  two  fluid 
ounces  of  syrup,  and  taken  as  lemonade. 

. 2.  Alkaline  Antilithicis. 

Alkalies,  as  already  remarked,  are  indicated  in  cases  of  lithic  de- 
positions ; in  which  they  seem  to  prove  beneficial  not  only  through 
their  action  in  the  stomach,  as  antacids,  but  likewise  by  passing  into 
the  mass  of  blood  and  being  separated  by  the  kidneys.  That  they 
do  act  in  the  latter  manner  is  shown  by  the  fact,  that  after  they  have 
been  administered  for  some  time,  the  urine,  from  being  acid,  is  ren- 
dered alkaline.  In  a state  of  health,  indeed,  the  constant  use  of 
alkalies  may  occasion  the  deposition  of  white  or  phosphatic  sediments. 
Mr.  Brande  has  affirmed,  that  he  has  known  soda  water,  exhibited 
in  a case  ojf  stone  in  the  bladder,  produce  abundance  of  white  sand, 
which  the  ignorance  of  the  patient  and  his  medical  attendant  led  them 
to  refer  to  the  solvent  power  of  the  medicine  upon  the  stone,  which 
they  thought  was  gradually  giving  way  and  being  voided  ; whereas 
great  mischief  was  doing,  by  giving  the  urine  more  than  its  usual 
tendency  to  ’deposit  the  phosphates,  and,  consequently,  to  augment 


296 


SPECIAL  ANTILITHICS. 


the  size  of  the  calculus.”  It  would  be  singular,  however,  were  the 
effect,  in  this  case,  to  be  referable  to  the  action  of  the  soda*  water, 
which,  as  generally  sold  in  the  shops,  contains  no  alkali  whatever, 
and  is  in  reality  acid  by  its  impregnation  with  carbonic  acid. 

Liquor  potas'sa:  or  Solution  of  potas'sa  was  at  one  time  more 
employed  as  an  antilithic  and  lithonthryptic  than  any  of  the  alka- 
lies. An  objection  urged  to  the  pure  alkalies  has  been,  that  they 
are  apt  to  induce  irritation  in  the  lining  membrane  of  the  sto- 
mach, and  such  might  be  the  case  if  they  were  given  in  very  large 
doses.  It  must  be  recollected,  however,  that  more  or  less  acid  is 
generally  present  in  that  organ,  by  means  of  which  a portion,  and, 
in  particular  cases,  the  whole  of  the  alkali  administered  may  be  neu- 
tralised. Cases  too,  are  recorded,  in  which  the  potassa  has  been 
administered  for  a long  period,  and  in  considerable  quantity,  with- 
out the  supervention  of  any  disagreeable  results.  One  patient  of  Dr. 
Marcet  took  it  regularly  for  ten  years,  and  during  that  time  passed 
many  calculi,  all  of  which  had  their  angles  rounded,  and  their  edges 
blunted,  ‘‘  in  a manner,  which  could  hardly  be  explained,  except 
from  the  long  continued  effect  of  the  alkaline  medicine.”  Still,  the 
bicarbonates  of  the  alkalies  are  devoid  of  the  causticity  of  the  pure 
alkalies,  whilst  they  have  the  same  antilithic  properties.  They 
ought,  consequently,  to  be  preferred. 

The  dose  of  Liquor  Potassse  is  ^x.  to  ^xxx.,  given  two  or  three 
times  a day  in  water.  Veal  broth  and  table  beer  have  been  recom- 
mended as  vehicles,  but  although  the  latter  disguises  the  urinous 
and  unpleasant  odour  of  the  alkali,  the  acid  of  the  beer  may  neutralise 
a portion  of  it ; and  the  beer  itself  is  but  little  calculated  for  the 
phosphatic  diathesis.  An  empirical  remedy  for  stone,  known  under 
the  name  of  Dr.  Chittick^s  nosti'um,  is  said  to  be  a solution  of  alkali 
in  veal  broth. 

Car'bonates  of  Potas  sa  and  Soda  are  milder  preparations  of 
the  alkalies,  and  yet  at  least  equally  effective  antilithics  with  the 
pure  alkali.  The  bicarbonate  of  soda  is  the  most  agreeable,  and  is 
probably  as  efficacious  as  any  of  these  preparations ; yet  the  use  of 
potassa  has  appeared  to  prove  beneficial  in  calculous  affections, 
where  soda  failed  to  afford  any  relief,  and  it  is  important  to  bear  in  mind 
a fact  mentioned  by  Prout,  that  the  urate  of  potassa  is  a soluble  salt, 
the  urate  of  soda  insoluble.  As  it  is  possible,  however,  that  the  main 
efficacy  of  antilithics  may  be  exerted  upon  the  first  passages,  and  on 
the  blood,  rather  than  on  the  kidneys,  the  circumstance,  mentioned 
by  Prout,  may  not  be  a valid  objection  to  the  use  of  soda.  Sir  Gil- 
bert Blane  accounted  for  the  greater  advantage  of  soda  in  calculous 
complaints  upon  the  assumption,  that  soda  becomes  applied  to  the 
purposes  of  the  economy  before  it  arrives  at  the  kidneys ; whereas 
potassa  passes  to  those  organs  to  be  thrown  off  from  the  system. 
The  dose  of  the  carbonates  of  potassa  and  soda  as  antilithics  is  from 


DIOSMA. 


297 


gr.  X.  to  ^ss  ; of  the  bicarbonates  of  the  same  alkalies,  from  gr.  xx. 
• to  5j.  They  may  be  given  in  water,  or  in  the  common  soda  water 
of  the  shops. 

Ammo'nia  and  Car'bonate  of  Ammo'nia  are  at  times  adminis- 
tered with  the  same  view.  Their  effects  would  seem  to  be  wholly 
exerted  upon  the  primse  vise  ; and  the  same  is  probably  the  case  with 
Magne'sia,  Car'bonate  of  Magne^sia,  and  Limewater.  The  first 
and  second  of  these  are  used  largely  as  antilithics.  Magnesia  was 
first  strongly  recommended  by  Mr.  Brande,  who  properly  remarks, 
that  under  its  use,  in  the  lithic  diathesis,  the  red  deposit  in  the  urine 
becomes  much  diminished,  or  disappears  altogether,  and  the  irrita- 
tion of  the  kidneys  is  proportionately  relieved.  It  must  be  borne  in 
mind,  however,  that  magnesia  sometimes  accumulates  in  the  bowels, 
when  it  is  given  for  a long  period.  Either  magnesia  or  its  carbo- 
nate may  be  prescribed  in  the  dose  of  from  gr.  x.  to  gr.  xxx.  in 
water  or  milk.  The  fluid  magnesia^  elsewhere  described,  (p.  159,) 
is  a good  preparation  in  these  cases.  It  is  a solution  of  magnesia  in 
carbonated  water. 

It  is  by  virtue  of  the  alkali  they  contain,  that  the  Vichy  waters, 
— ^ already  referred  to  — are  so  celebrated  in  France  in  calculous 
cases,  'khese  are  in  such  high  repute,  that  they  are  directed  to  be 
prepared  artificially,  and  are  sent  to  every  part  of  Europe  ; but  it 
need  scarcely  be  said,  that  no  artificial  or  real  water  drunk  away 
from  the  spring,  and  therefore  without  the  accompanying  advan- 
tages of  travelling  air  and  exercise,  can  be  regarded  as  substitutes 
for  the  water  taken  at  the  source.  The  following  form  for  the 
artificial  Vichy  water  is  given  in  the  Codex  Medic amentarius  of 
Paris  : 

Take  of  simple  acidulous  water ^ impregnated  with  twice  its  bulk 
of  Carbonic  acid,  ^xxss ; Carbonate  of  soda,  gr.  xxxij  ; Sulphate  of 
soda,  gr.  xvj  ; Muriate  of  soda,  gr.  iv  ; Carbonate  of  magnesia,  gr.  ss  ; 
Muriate  of  iron,  gr.  J.  — M. 

In  this  country,  the  Saratoga  waters  constitute  an  excellent  remedy, 
and  not  the  less  so  from  the  slight  impregnation  of  iron,  which 
they  contain. 

3.  Tonic  Antilithics. 


1.  DIOS'MA.  — BUCHU. 

The  Pharmacopoeia  of  the  United  States,  along  with  those  of 
London  and  Dublin,  refers  Buchu  leaves  to  Dios'ma  crenaJta,  whilst 
the  Edinburgh.  Pharmacopoeia  assigns  them  to  various  species  of 
Baros'ma.  “ This  drug” — says  Dr.  Christison — furnishes  a good 
illustration  of  the  inconvenience  of  attempting  a correct  botanic 
nomenclature  of  the  articles  of  the  Materia  Medica.  It  has  been 
known  in  Britain  for  about  twenty  years  under  its  original  Hottentot 
name  of  Buckhu  or  Buchu  ; but  the  London  College  had  scarcely- 
admitted  it  into  the  Pharmacopoeia  under  the  botanical  name  of 
Diosma,  before  botanists  discovered  that  the  plant  or  plants  from 


298 


SPECIAL  ANTILITHICS. 


which  it  is  obtained  must  be  removed  into  a new  genus,  now  termed 
Barosma.^"^ 

Dios'ma  or  Baros'ma^  Sex.  Syst.  Pentandria  Monogynia  ; Nat. 
Ord.  Rutacese,  is  a native  of  Southern  Africa,  near  the  Cape  of 
Good  Hope.  Several  species  are  used  by  the  Hottentots,  on  ac- 
count of  their  odorous  and  medicinal  virtues.  A powder,  which 
they  use  for  anointing  their  bodies^  is  composed  of  various  odorous 
matters,  and  chiefly  of  Barosmas.  They  are  small  shrubs,  which  have 
a heavy  and  peculiar  smell ; hence  the  name  Barosma  — from 
‘heavy,’  ‘powerful,’  and  ‘ odour,’  — by  some  considered  ‘di- 
vine’ ; hence  the  name  Diosma^  from  //o?,  ‘ divine,’  and  ‘ odour.’ 

Buchu  leaves  — as  met  with  in  the  shops  — are  composed  of 
those  of  several  species  of  barosma,  intermixed  with  stalks  and  fruit. 
They  are  smooth,  somewhat  shining,  sharply  or  bluntly  serrated  or 
crenated,  and  are  studded  with  little  oil  vesicles,  containing  the 
essential  oil,  which  gives  them  a portion  of  their  odour.  The  taste 
of  the  leaves  is  aromatic,  somewhat  pungent,  and  bearing  some  re- 
semblance, according  to  Buchner,  to  peppermint.  Others,  however, 
compare  it  to  rue  ; others  to  rosemary  ; others  to  cumin  ; and  others, 
again,  to  the  urine  of  the  cat.  (Pereira.) 

The  main  constituents,  afforded  by  analysis,  are  a volatile  oil, 
of  a yellowish-brown  colour,  and  lighter  than  water,  which  has  the 
odour  of  the  leaves,  — and  a bitter  extractive  matter,  Diosmin. 
The  leaves  afford  their  virtues  to  both  water  and  alcohol. 

The  medical  properties  of  diosma  — like  those  of  the  other  arti- 
cles under  this  head  — have  been  greatly  exaggerated.  By  virtue 
of  the  volatile  oil,  they  are  excitant,  and  perhaps  slightly  diuretic  ; 
and,  by  their  bitter  extractive,  tonic.  They  are,  consequently, 
adapted  for  giving  tone  to  the  digestive  organs,  and  through  them 
to  the  general  system  ; but  the  evidence  is  utterly  inadequate  to 
show,  that  they  have  otherwise  any  effect  in  calculous  diseases  ; or 
that  they  possess  any  special  action  on  the  urinary  organs.  Dr. 
Wood  has  correctly  remarked,  that  “ they  are  chiefly  given  in  com- 
plaints of  the  urinary  organs,  such  as  gravel,  chronic  catarrh  of  the 
bladder,  morbid  irritation  of  the  bladder  and  urethra,  disease  of  the 
prostate,  and  retention  or  incontinence  of  urine  from  a loss  of  tone 
in  the  parts  concerned  in  its  evacuation;”  — and  he  might  have 
added,  from  his  extensive  acquaintance  with  the  subject,  — that  we 
are  not  in  possession  of  any  remedy  which  could  act  beneficially  in 
diseases  of  such  opposite  characters.  The  suggestion,  that  in  lithiasis, 
attended  with  increased  secretion  of  uric  acid,  diosma  should  be 
given  in  combination  with  alkalies,  is  good,  inasmuch  as  in  this 
manner  we  neutralise  any  preponderance  of  acid ; "whilst,  at  the 
same  time,  we  give  tone  to  the  system,  and  thus  remove  the  ten- 
dency to  its  fresh  generation. 

The  dose  of  the  powder  is  from  gr.  xx.  to  ^ss. 

roU'SUM  DIOSmiNFU'SION  OF  BUCIIU.  {Diosmce,  5J ; Jlq.  hullient.  Oj. ) 
Dose,  f.  |j.  to  f.  5ij. 


PAREIRA, 


299 


The  Dublin  Pharmacopceia  has  a Tincture  of  Diosma,  {Diosm. 
Jv;  Alcohol,  dilut.  Oij  ; — made  either  by  maceration  or  percola- 
tion,) the  dose  of  which  is  from  f.  5).  to  f.  §ss. 

2.  PAREFRA.  — PAREI'RA  BRAVA. 

Pareira  of  the  Pharmacopoeias  is  the  root  of  Cissam' pelos  Parei'ra^ 
Parei’ra  Brava  or  Velvet  leaf ; Sex.  Syst.  DioeciaMonadelphia  ; Nat. 
Ord.  Menispermacese,  a climbing  plant,  which  is  a native  of  South 
America  and  the  West  India  islands. 

The  root  — as  met  with  in  the  shops  — is  in  roundish  pieces,  from 
half  an  inch  to  four  inches  in  diameter  ; from  four  inches  to  some 
feet  in  length,  and  often  split  longitudinally.  The  epidermis  is  thin, 
of  a brown  colour,  furrowed  longitudinally,  and  wrinkled  trans- 
versely. The  interior  of  the  root  is  of  a yellowish  colour,  very  po- 
rous, and  marked  by  irregular  concentric  circles.  It  is  devoid  of 
smell,  and  has  a sweetish  and  afterwards  nauseous  bitter  taste. 

The  active  principle  of  the  root  is  considered  to  reside  in  a yel- 
low bitter  matter,  which  is  soluble  in  both  alcohol  and  water.  A 
new  vegetable  alkaloid  principle  has  been  separated  by  Wiggers,  to 
which  he  gave  the  name  Cissampeli'na  ; but  whose  properties  have 
not  been  described. 

Pareira  yields  its  medical  virtues  to  water,  and  hence  an  extract, 
and  an  infusion,  are  officinal  in  the  London  and  Edinburgh  Pharma- 
copoeias. The  Pharmacopoeia  of  the  United  States  has  no  officinal 
preparation  of  it.  The  same  properties  have  been  assigned  to  it  as 
to  the  diosma  ; with  the  addition,  that  it  was  at  one  time  highly 
extolled  as  a lithonthryptic ; and  it  was  even  affirmed,  that  calculi  — 
the  size  of  an  olive  — had  disappeared  under  its  administration. 
The  author  has  carefully  watched  its  effects,  but  neither  in- its  gene- 
ral action  on  the  system,  nor  in  its  effects  in  calculous  depositions, 
*iOr  in  chronic  diseases  of  the  urinary  organs,  has  he  seen  any  other 
properties  than  those  possessed  by  the  ordinary  bitter  tonics  ; and, 
where  other  results  have  supervened,  in  the  practice  of  others,  it  is 
probable  that  they  were  owing  to  the  system  of  medication  com- 
bined with  it.  . He  has  not  had  the  shadow  of  a reason  for  believ- 
ing it — as  suggested  by  Dr^  Christison  — ‘‘to  possess  specific  vir- 
tues over  various  disorders  of  the  urinary  organs,  more  especially 
chronic  inflammation  of  the  bladder.”  “ A careful  inquiry  into  its 
physiological  action,”  says  the  writer  just  cited,  “ is  much  wanted; 
for  some  have  failed  to  observe  the  diuretic  and  aperient  properties 
ascribed  to  it  by  others  ; and  they  are  disposed  to  think,  as  would 
be  anticipated  alike  from  its  sensible  qualities,  and  its  place  in  the 
natural  arrangement  of  vegetables,  that  it  is  nothing  else  than  an 
excellent  tonic  bitter,  akin  to  calumba.  The  authority  of  Sir  B. 
Brodie,  v-ho  has  recommended  it  in  chronic  urinary  diseases,  and 
especially  in  chronic  inflammation  of  the  urinary  bladder,  has  of  late 
brought  it  into  general  employment.  The  information  communi- 
cated to  me  on  this  point  by  various  surgeons  here  who  have  made 
trial  of  it  is  not  in  its  favour.” 


300 


SPECIAL  ANTILITHICS. 


Sir  Benjamin  recommends  a decoction  prepared  by  simmering 
four  ounces  of  the  root  in  three  pints  of  water,  until  the  fluid  is  re- 
duced to  two  pints.  From  six  to  twelve  fluidounces  of  this  decoc- 
tion may  be  taken  in  the  twenty-four  hours ; but  it  is  important  to 
add,  in  judging  correctly  of  its  virtues,  that  Sir  Benjamin  is  in  the 
habit  of  adding  to  it  the  tincture  of  hyoscyamus  ; and  where  there 
is  any  deposition  of  the  triple  phosphates,  indicated  by  milky  urine, 
with  an  iridescent  pellicle  on  the  surface,  he  adds  the  muriatic  or 
the  nitric  acid,  — agents  which,  of  themselves,  are  most  valuable 
antilithics. 

The  Infusum  PAREiRiE  of  the  London  and  Edinburgh  Pharmaco- 
poeia is  made  by  macerating  six  drachms  of  Pareira  in  a pint  of 
boiling  water.  The  dose  of  this  is  from  f.  jj  to  f.  Jiij-  The  Ex- 
TRACTUM  Pareira:  of  the  same  pharmacopoeia  is  prepared  in  the 
same  manner  as  the  extract  of  gentian.  Its  dose  is,  gr.  x.  to  5ss  ; 
and  it  is  often  given  along  with  the  Infusion. 


3.  VVA  URSI. 

Uva  Ursi,  in  the  London  and  United  States  Pharmacopoeias,  is  the 
officinal  name  for  the  leaves  of  Ar'hutus  Uva  Ursi,  Arctostaph' 
yhs  Uva  Ursi^  Bearherry  or  BeaUs  Who rtle' berry : Sex.  Syst.  De- 

candria  Monogynia ; 
Fig.  4.3.  Nat.  Order,  Erica- 

cese  ; a low  evergreen 
shrub,  which  is  a na- 
tive of  the  northern 
latitudes  of  Europe, 
Asia  and  America.  On 
the  American  conti- 
nent, it  extends  from 
Hudson’s  Bay  as  far 
southward  as  New 
Jersey,  whence  it  is 
obtained  for  the  mar- 
ket of  Philadelphia. 
(Wood&Bache.)  The 
leaves  are  gathered  in 
autumn,  and  the  green 
ones  are  selected. — 
They  are  apt  to  be 
mixed  with  Vaccin'- 
ium  Vitis  Idee’ a or 
Red  Whortle' berry,,  a 
plant  of  the  same  na- 
tural family,  the  leaves 
of  which  are  minutely 
Arbutus  uvn  iir^i.  tootlicd,  aiid  the  Under 

surface  dotted  ; whereas  the  edges  of  the  genuine  leaves  are  entire 


DIAPHORETICS. 


301 


and  the  under  surface  reticulated.  Moreover,  the  spurious  leaves 
are  deficient  in  astringency,  a remark  which  applies  to  the  box-leaf, 
which  is  sometimes  mixed  with  it;  — the  true  uva  ursi  leaf  having 
a bitterish  and  strongly  astringent  taste,  but  no  odour  except  when 
in  powder.  It  then  resembles  that  of  hay.  Its  virtues,  which  are 
mainly  dependent  upon  tannic  acid,  are  yielded  to  water  and  alco- 
hol. The  tannic  acid  — as  elsewhere  observed  — is  the  gTeat  as- 
tringent principle  of  vegetables. 

Uva  Ursi  is  possessed  of  the  powers  of  the  ordinary  astringents,  but, 
so  far  as  the  author  has  observed,  of  nothing  more  ; yet  it  has  all 
the  virtues  ascribed  to  it  that  have  been  assigned  to  Diosma  and  Pa- 
reira.  It  has,  indeed,  been  regarded  as  a specific  in  diseases  of 
the  kidneys  and  bladder  at  large.”  In  recent  times,”  says  Dr. 
Christison,  it  has  been  succeeded,  as  a panacea  in  urinary  diseases, 
by  the  Pareira  brava  root  — probably” — he  gravely  adds,  with- 
out sufficient  reason.”  Nothing  can  be  more  feeble  than  the  testi- 
mony, which  has  been  brought  forward  in  favour  of  its  specific  affi- 
nity for  the  urinary  organs,  and  accordingly  the  confidence  of  sur- 
geons in  regard  to  it  is  becoming  less  and  less  ; or  at  all  events 
their  sentiments  are  highly  discordant.  As  an  antilithic  it  appears 
to  act  solely  by  its  tonico-astringent  properties. 

The  dose  of  the  powdered  uva  ursi  is  from  9j  to  ^j,  given  three 
or  four  times  a day  ; but  the  form  usually  preferred  is  the 

hECOC'TUM  ITT  URSI,  DECOCTION  OF  LTA  URSI.  J Uvce  tfjsi,  ; .^quce 
f.  5^x.  Boil  to  a pint).  The  dose  is  from  f.  3j  to  f.  ^ij,  three  or  four 
times  a day. 


V.  DIAPtlORET'ICS. 

Stnon.  Diapnoica. 

Definition  of  diaphoretics — Largely  invoked  in  Therapeutics — Disease  not  often  induced 
by  suppressed  perspiration — Modus  operandi  of  diaphoretics — Are  indirect  agents — 
How  their  operation  may  be  aided — Their  therapeutical  application — Special  diapho- 
retics. 

Diaphoretics  are  defined  to  be  — “ agents  that  augment  the  func- 
tion of  transpiration.” 

As  it  was  at  one  time  imagined,  that  almost  every  disease,  to 
which  mankind  are  liable,  is  produced  by  obstructed  perspiration, 
the  class  of  diaphoretics  was  extensively  employed  in  medical  prac- 
tice, and  numerous  agents  were  admitted  into  the  catalogues  of  the 
materia  medica,  which  were  supposed  toffie  capable  of  augmenting 
the  cutaneous  exhalation.  Even  yet,  this  cause  of  disease  is  re- 
peatedly referred  to,  not  only  by  the  unprofessional,  but  by  many  of 
the  profession.  ‘‘  Health,”  says  a modern  writer.  Dr.  Eberle,  is 
very  intimately  connected  with  the  regular  performance  of  the  per- 
spiratory function.  Whenever  the  transpiration  by  the  skin  is  sud- 
voL.  I. — 26 


302 


DIAPHORETICS, 


denly  checked,  more  or  less  derangement  of  the  system  is  invariably 
the  consequence.  That  portion  of  the  circulating  fluid,  which  na- 
ture designs  to  be  cast  off  by  the  cutaneous  emunctories,  is  no  longer 
fit  for  the  purposes  of  the  animal  economy  ; is  retained  and  becomes 
a source  of  morbific  irritation  to  the  heart  and  other  organs.”  Dis- 
ease,” says  another  writer.  Dr.  A.  T.  Thomson,  “ is  frequently  the 
consequence  of  a sudden  check  to  the  perspiratory  function  : means, 
therefore,  have  been  sought  for  to  restore  it  ; and  the  substances, 
classed  as  diaphoretics,  are  supposed  to  have  that  power.” 

It  may  admit,  however,  of  well-founded  doubt,  whether  disease  be 
ever  induced  by  suppression  of  the  cutaneous  exhalation.  The  two 
great  fluids  of  depuration  are  the  transpiration  — cutaneous  and 
pulmonary  — and  the  urine.  In  summer,  the  former  predominates 
over  the  latter,  whilst  in  winter  the  opposite  is  the  fact.  Hence,  there 
appears  to  be  a sort  of  compensation  effected  between  the  two  depura- 
tions, so  that  if  one  be  diminished  by  a change  of  atmospheric  tem- 
perature, the  other  is  augmented.  For  this  reason,  we  should  not 
anticipate  extensive  morbid  results  from  a general  check  given  to 
perspiration,  were  we  even  ignorant  of  the  impunity,  with  which 
we  may  pass  from  a heated  apartment  to  the  external  air,' and  which 
follows  the  use  of  the  cold  bath,  after  the  individual  has  been  ex- 
posed to  a very  elevated  temperature,  as  in  the  Russian  vapour-bath. 
Observation  has,  indeed,  sufficiently  shown,  that  danger  is  less  to 
be  apprehended  from  such  general  checks,  than  from  the  partial  and 
irregular  application  of  cold  and  moisture.  The  danger  of  having 
the  feet  cold  and  wet,  or  of  sitting  with  a part  of  the  body  exposed 
to  a draught  of  cold  air,  is  proverbial;  yet,  if  we  attempt  to  explain 
this  by  the  check  given  to  perspiration,  we  fail  ; for  the  loss  of  the 
ordinary  depuration,  in  so  small  a portion  of  the  body,  is  obviously 
insufficient  to  account  for  the  phenomena ; yet,  disease  is  far  more 
apt  to  be  induced,  in  such  case,  than  when  the  whole  body  is  ex- 
posed to  a sudden  alternation  of  temperature  from  hot  to  cold,  and 
when  the  check  to  the  cutaneous  depuration  ought  necessarily  to 
be  to  a much  greater  extent.  The  author  has  elsewhere  remarked, 
{Human  Healthy  p.  45.  Philad.  1844),  thatthere  is  perhaps  in  every 
one,  at  any  one  particular  time,  some  organ  or  tissue  of  the  body 
more  disposed  to  take  on  morbid  action  than  another  ; and  that,  be- 
tween every  part  of  the  capillary  surface  such  an  extensive  sympathy 
reigns,  that  if  one  part  be  irregularly  and  morbidly  impressed  ; such 
impression  vibrates  to  every  part  of  the  system,  so  that  the  tissue  or 
organ  most  disposed  to  take  on  morbid  action  at  the  time,  assumes 
it.  Hence,  if  a dozen  individuals  be  exposed  to  the  irregular  ap- 
plication of  cold  and  moisture  to  the  feet,  they  may  not  all  have  the 
same  disease  induced,  because  in  all  there  was  not,  at  the  time,  the 
same  disposition  in  a particular  organ  or  tissue  to  the  assumption  of 
disease. 

'rhis  irregular  action  of  the  capillaries  of  the  part  is  the  first  link 
in  the  chain  of  phenomena,  not  the  obstruction  of  perspiration.  On 


ACTION  OF. 


303 


this  head,  a modern  writer,  Dr.  W.  F.  Edwards,  of  Paris,  has  ex- 
pressed himself  in  a sound  and  rational  manner.  The  insensible 
perspiration  he  regards  as  a purely  physical  phenomenon  of  evapo- 
ration,” whilst  the  sensible  ‘‘  is  a loss  ordinarily  produced  by  a vital 
action,  in  the  form  of  a liquid  which  transudes.”  In  prosecuting 
the  consideration  of  this  subject,  he  remarks  ; — “ all  that  we  have 
hitherto  shown  on  the  subject  of  perspiration  will  considerably  facili- 
tate our  examination  of  a question,  which  naturally  presents  itself. 
Is  perspiration  susceptible  of  being  suppressed  ? It  is  easier  to  re- 
solve this  question  with  regard  to  man  and  other  warm-blooded  ani- 
mals, than  with  respect  to  the  cold-blooded  vertebrata.  Let  us  see  what 
is  the  result  of  a very  low  temperature  upon  warm-blooded  animals. 
We  know  by  the  effect  of  cold  upon  the  sweat,  that  it  diminishes 
transudation.  Now  let  us  suppose,  that  it  may,  by  its  intensity,  sup- 
press it  altogether,  there  will  remain  perspiration  by  evaporation, 
which  will  always  take  place,  however  humid  the  air  may  be.  The 
high  temperature  of  man,  and  other  warm-blooded  animals,  warms 
the  air  in  contact  with  the  body,  and  changes  its  hygrometric  state 
by  removing  it  from  its  extreme  of  humidity,  and  consequently  oc- 
casions evaporation.  If,  on  the  other  hand,  the  temperature  of  the 
air  be  raised  to  an  equality  with  that  of  the  body,  at  the  time  that  it 
is  saturated  with  humidity  in  order  to  suppress  evaporation,  then 
perspiration  by  transudation  is  excited,  and  takes  place  to  such  an 
extent  in  man  and  other  warm-blooded  animals,  that  the  sweat  will 
stream  from  all  parts  of  the  body.  We  can  then,  in  no  case,  sup- 
press the  perspiration  ; it  will  be  performed  either  by  evaporation  or 
by  transudation.  We  ought  therefore  to  be  careful,  how  we  take 
literally  what  we  find  in  medical  books  respecting  suppressed  per- 
spiration. There  can  be  no  such  thing.  That  there  may  be  sup- 
pression of  sweat  is  evident  to  everyone;  but  it  does  not  follow 
that,  even  in  these  cases,  there  is  no  transudation. 

“ Since  it  is  difficult  to  assure  ourselves  directly,  whether  transu- 
dation is  ever  entirely  suppressed  in  man,  and  other  warm-blooded 
animals,  let  us  see  what  the  cold-blooded  vertebrata  will  offer  on 
this  point.  The  batrachians  are  the  best  adapted  to  this  kind  of  re- 
search, on  account  of  the  nakedness  of  their  skin,  of  the  fineness 
of  its  texture,  of  the  copious  loss,  which  may  be  incurred  through 
its  medium,  and,  consequently,  of  the  relation  which  their  perspira- 
tion bears  to  that  of  man.  On  exposing  frogs  to  the  temperature  of 
0°  Cent.  (32°  Fahr.)  in  humid  air,  in  order  to  suppress  perspiration 
by  evaporation,  they  have  lost  by  transudation,  in  different  experi- 
ments, the  thirtieth  part  of  their  weight.  Transudation  is  more 
abundant  in  these  animals  than  in  man,  though  the  latter  be  placed 
in  circumstances  much  more  favourable.  When  we  consider  how 
sensible  these  creatures  are  to  cold,  how  much  the  activity  of  all 
their  functions  is  diminished  at  a low  temperature,  and  how  much 
they  may  even  then  lose  by  transudation,  it  is  not  to  be  supposed, 
that  cold  suppresses  this  mode  of  perspiration  in  man,  and  the  less 


304 


DIAPHORETICS, 


SO  from  his  having  a temperature  of  his  own,  which  varies  very  little 
with  the  changes  of  the  atmosphere,  a condition  which  has  a pow- 
erful tendency  to  maintain  transudation.  It  may  be  very  much  di- 
minished by  the  action  of  cold,  but  it  appears  that  it  cannot  be  alto- 
gether suppressed.  It  is  a remarkable  but  well  known  fact,  that 
when  life  is  sinking,  and  to  appearance  nearly  extinct,  the  body  is 
covered  wdth  sweat  — so  strong  is  the  tendency  to  continue  this 
function.” 

In  any  mode,  consequently,  of  viewing  the  subject,  it  does  not 
appear  that  w^e  can  ascribe  any  extensive  series  of  morbid  pheno- 
mena to  simple  suppression  of  perspiration.  Such  being  the  fact, 
the  indication  of  restoring  suppressed  perspiration  — if  it  be  admit- 
ted at  all — must  exist  much  less  frequently  than  has  been  imagined. 
Yet  there  are  but  few  classes  of  remedies,  that  are  more  used,  espe- 
cially by  the  older  practitioners,  than  diaphoretics,  and  probably  none 
which  are  more  uncertain  in  their  operation,  and  on  which  less  reli- 
ance ought  to  be  placed.  Most  of  them,  too,  are  agents,  which  sti- 
mulate the  heart  and  arteries,  and  hence  the  indiscriminate  employ- 
ment of  heating  diaphoretics  has  been  productive  of  much  mischief 
in  febrile  and  inflammatory  disorders.  In  a state  of  health,  any 
thing,  which  gives  occasion  to  the  greater  propulsion  of  blood  into 
the  cutaneous  capillaries,  will  produce  diaphoresis.  In  this  way, 
exercise  and  external  heat  exert  a diaphoretic  agency ; but  when  the 
capillary  action  is  in  a state  of  exaltation  from  disease,  the  same 
agencies  are  not  followed  by  a like  result.  This  state  of  exaltation 
has  to  be  reduced  before  diaphoresis  can  be  effected.  The  same 
thing  is  also  exhibited  in  another  way.  During  the  heats  of  sum- 
mer, the  cutaneous  capillaries  are  kept  in  a state  of  perpetual  ere- 
thism, and  although  the  sensible  perspiration  may  be  exhaled  to  a 
great  extent,  it  would  probably  be  more  largely  elicited  were  the 
erethism  less  ; accordingly,  when  we  take  iced  water  or  any  iced 
drink  under  such  circumstances,  the  refrigerant  influence  is  exerted 
on  the  capillaries  of  the  stomach,  and,  owing  to  the  extensive  sym- 
pathy that  exists  between  every  part  of  the  capillary  surface,  the 
cooling  influence  is  at  once  communicated  to  the  whole  capillary 
system  ; the  erethism  is  thus  reduced,  and  copious  perspiration 
ensues.  Every  one  must  have  observed  how  rapidly  the  sensible 
perspiration  is  thrown  out  in  hot  weather  after  the  use  of  iced  drinks. 
The  eflect  is  here  diaphoresis,  but  the  remedy  operates  as  a rejrige- 
rant  — a class  of  agents  far  more  efficacious  than  diaphoretics.  It 
may  be  doubted,  indeed,  whether  we  have  any  internal  remedies, 
which  are  capable  of  acting  as  direct  diaphoretics  — that  is,  by  vir- 
tue of  specific  properties,  which  they  possess  over  the  glandular  or 
diapnogenous  apparatus  of  the  skin.  Dr.  Paris  thinks,  that  mercu- 
rials and  sulphur  act  in  this  way,  but  the  only  evidence  we  have  of 
this  is,  that  they  pass  off  by  the  skin,  and  as  they  emerge  from  the 
system  in  this  manner,  it  would  be  fair,  perhaps,  to  presume,  that 
they  may  act  on  the  cutaneous  capillaries,  but  we  have  no  evidence 
in  favour  of  their  producing  augmented  diaphoresis. 


ACTION  OF. 


305 


The  author,  to  whom  allusion  has  just  been  made,  has  given 
the  following  table  of  what  he  considers  the  modus  operandi  of  dia- 
phoretics. 

“ Diaphoretics 

I 

Occasion  their  effects  — 

I.  By  stimulating  the  cutaneous  capillaries. 

A.  By  external  application. 

The  stimulus  of  heat^  frictions^ 

B.  By  medicines  which  enter  the  circulation  and  stimulate 
the  cutaneous  vessels  by  contact. 

Mercurials  — sulphur. 

c.  By  medicines  which  act  on  the  surface  sympathetically ^ 
through  the  medium  of  the  stomach. 

Cold  drinks j ^'c. 

II.  By  increasing  the  general  action  of  the  vascular  system. 

Violent  exercise  — Jimmonia — Guaiacum — Alcohol^ 

Warm  hath. 

III.  By  relaxing  the  morbidly  constricted  mouths  of  the  perspi- 
ratory vessels. 

Antimonials — Cold  affusion — Venesection  — Saline 

diaphoretics.'^'^ 

It  has  been  seen,  that  the  modus  operandi  of  cold  drinks  cannot 
be  referred  to  any  “ stimulation”  of  the  cutaneous  capillaries,  and 
the  same  may  be  said  of  the  warm  bath,  which  certainly  does  not 
operate  by  increasing  the  general  action  of  the  vascular  system. 
Such  may  be,  and  is,  the  effi^ct  of  the  hot  bath  — aqueous,  vapour, 
or  air  — but  the  warm  bath  acts  precisely  like  the  cold,  by  diminish- 
ing the  action  of  vessels.  A mistake  is  often  made,  and  a hot  stimu- 
lating bath  is  occasionally  administered  in  violent  inflammatory 
attacks,  instead  of  the  warm  and  soothing,  — to  the  manifest  detri- 
ment of  the  sufferer.  The  application  of  warmth,  in  the  form  of  the 
vrarm  water  bath,  is  one  of  the  most  valuable  therapeutical  agents 
which  we  possess  ; especially  in  the  inflammatory  and  spasmodic 
disorders  incident  to  childhood.  At  one  time,  the  salutary  agency 
was  universally  ascribed  to  the  restoration  of  suppressed  perspira- 
tion. It  is  now  known  to  modify  the  condition  of  the  capillary 
system,  reducing  it  when  over -excited,  and  producing  a beneficial 
action  of  equalisation  in  the  circulatory  movements,  so  as  to  di- 
minish the  exaltation  of  vital  manifestations  in  the  organ  labouring 
under  inflammation  or  spasm. 

In  reality,  there  are  no  substances,  administered  as  diaphoretics, 
on  whose  direct  agency  much  dependence  can  be  placed,  unless 
they  are  such  as  are  made  to  come  in  contact  with  the  cutaneous 
surface.  Diaphoresis  follows  the  employment  of  many  internal 
26* 


306 


DIAPHORETICS, 


means,  but  the  result  is  produced  indirectly.  Antimonials,  for  ex- 
ample, have  been  much  relied  upon  for  ‘^relaxing  the  morbidly  con- 
stricted mouths  of  the  perspiratory  vessels but  this  result  is  not 
produced  by  any  specific  action  on  those  vessels,  so  much  as  by  ex- 
citing a new  impression  on  the  system,  which  breaks  in  upon  the 
cutaneous  erethism.  Perhaps  we  have  no  class  of  remedies  more 
uncertain  in  their  operation  than  anatomical  diaphoretics,  as  ordi- 
narily administered.  It  might,  indeed  be  said,  that  there  are  no 
agents  so  devoid  of  any  beneficial  action ; yet,  if  they  are  given  so 
as  to  excite  nausea,  or  a state  approaching  this,  diaphoresis  often 
results,  but  then  it  is  immediately  produced  by  the  state  of  dimi- 
nished vital  activity,  occasioned  by  the  remedy  acting  as  a nause- 
ant — a set  of  agents  possessed  — as  has  been  seen — of  the  most 
valuable  properties  for  reducing  morbid  exaltation  of  the  vital  forces. 
The  faith,  however,  that  has  existed  in  antimonials,  as  usually  pre- 
scribed, for  exerting  a febrifuge  action,  has  not  been  without  its  ad- 
vantages. Whilst  trust  is  reposed  in  them,  the  feverish  invalid  is 
left  in  quietness,  and  the  irritating  system  of  cathartic  after  cathartic 
is,  for  the  time,  dispensed  with  ; but  that  the  antimonial  is,  in  many 
cases,  inert,  has  been  sufficiently  shown  from  numerous  experiments 
with  Pulvis  Jlntwioni all's  of  the  pharmacopoeias — a powder  intro- 
duced as  a factitious  James'' s FowdeP^  — which  have  demonstrated, 
that  the  preparation  is  often  almost  wholly  inoperative,  even  when 
given  in  very  large  doses.  It  is  rarely  employed  on  the  continent 
of  Europe  ; but  confidence  is  still,  although  unworthily,  reposed  in 
it  by  many  practitioners  of  this  country,  and  of  Great  Britain.  ‘‘  The 
utmost  diversity  of  opinion,”  says  Dr.  A.  T.  Thomson,  exists  re- 
specting the  utility  of  this  preparation  ; many  practitioners  contend- 
ing that  it  is  perfectly  inert,  others  asserting,  ‘ that  it  is  one  of  the 
best  antimonials  we  possess.’  ' From  the  result  of  its  administration 
in  my  own  practice,  I cannot  place  any  confidence  in  its  diaphoretic 
powers.  If  there  be  much  muriatic  acid  present  in  the  stomach,  it 
may  prove  active  ; but  in  general  it  displays  no  influence  whatever 
on  the  system.  It  has  been  given  in  doses  of  sixty,  eighty,  and 
one  hundred  and  thirty  grains  without  any  sensible  effect.  Its  oc- 
casional activity  may  be  ascribed  to  the  oxide  being  accidentally  in 
the  state  of  a protoxide.” 

The  results  of  the  author’s  observations  have  led  him  to  conclu- 
sions identical  with  those  of  Dr.  Thomson,  yet  he  can  well  recollect 
how  strongly  it  was  urged,  by  an  old  and  venerated  preceptor,  to 
place  full  reliance  upon  the  six  or  eight  grain  doses  of  this  prepa- 
ration, in  cases  where  a febrifuge  was  needed,  and  to  be  especially 
careful  not  to  exceed  this  quantity,  lest  emesis  should  be  induced. 

In  every  case,  in  which  the  skin  is  hot  and  dry,  and  the  indica- 
tion appears  to  be,  to  establish  diaphoresis,  the  cause  of  this  condi- 
tion of  the  cutaneous  exbalants  must  be  inquired  into,  and,  if  pos- 
sible, removed.  Hence  it  is,  that  the  well-instructed  practitioner 
employs  indirect  diaphoretics  rather  than  such  as  are  esteemed 


ACTION  OF. 


307 


direct.  Thus,  diminished  sensible  exhalation  takes  place  from  the 
skin,  during  the  existence  of  fever  or  of  inflammation,  but  the  phy- 
sician does  not  have  recourse  to  any  reputed  diaphoretic,  which  acts 
by  exciting  the  sanguiferous  systemi  He  adapts  his  antiphlogistic 
remedies,  so  as  to  reduce  the  already  too  much  excited  condition  of 
the  blood-vessels  to  the  healthy  standard,  and  he  finds,  when  he  has 
removed  the  internal  inflammation,  the  heat  and  dryness  of  the 
skin  subside,  and  diaphoresis  satisfactorily  established.  Under  si- 
milar circumstances,  a full  dose  of  opium  is  attended  with  a similar  re- 
sult. Opium,  in  a large  dose,  exerts  sedative  properties.  When, 
therefore,  inflammation  is  present,  sedation  is  produced  by  the  drug; 
nervous  and  sanguiferous  excitation  are  allayed,  and  the  skin  be- 
comes cool  and  moist.  Hence  it  is,  that  morphia,  in  large  doses,  is 
often  so  powerfully  diaphoretic. 

One  of  the  most  celebrated  diaphoretics,  or  — for  the 

latter  term  is  more  frequently  employed  where  the  medicine  is  con- 
sidered capable  of  inducing  sweating  — is  a combination  of  opium 
with  ipecacuanha.  Opium,  in  a small  dose,  is  a stimulant ; in  a 
large  one,  a sedative.  Ipecacuanha,  in  a full  dose,  is  an  emetic  ; in 
a small  one,  a nauseant,  and,  by  virtue  of  the  latter  property,  a dia- 
phoretic. Ten  grains  of  "pulvis  ipecacuaiihce  et  opii — Dover’^s  powder 
— contain  one  of  opium,  and,  under  the  combined  action  of  the 
substances  in  this  dose,  augmented  exhalation  from  the  skin  takes 
place  as  surely  as  after  the  administration  of  any  internal  diaphore- 
tic agent.  It  has  been  the  fashion  to  explain  its  action  by  supposing, 
that,  whilst  the  opium  increases  the  force  of  ‘the  circulation,  the  ipe- 
cacuanha relaxes  the  exhalant  vessels,  and  causes  a copious  diapho- 
resis. This,  how^ever,  is  an  improbable  hypothesis,  and  the  true  ex- 
planation perhaps,  is,  — that  the  combined  influence  of  the  tw^o 
agents  is  exerted  on  the  vascular  and  nervous  systems,  so  as  to  re- 
duce inordinate  activity  ; in  this  way,  the  erethism  of  the  capilla- 
ries, consequent  on  irritation  existing  elsewhere,  is  removed,  and 
the  cutaneous  exhalation  becomes  manifest.  It  cannot  be  denied, 
that  there  may  be  remedies,  w^hich  may  hurry  the  circulation,  and 
others  that  may  relax  the  cutaneous  exhalants,  but  it  is  not  easy  to 
conceive,  that  they  can  be  readily  brought  to  act  simultaneously,  and 
it  is  easier  to  account  for  the  induction  of  diaphoresis,  by  such  com- 
pound remedies  as  the  pulvis  ipecacuanhce  et  opii^  upon  general  prin- 
ciples, than  by  invoking  specific  influences,  of  the  reality  of  w^hich 
w’e  must  remain  in  strong  doubt. 

It  has  been  already  remarked,  that  nauseants  act  as  the  most 
effective  diaphoretics.  Their  operation  is,  of  course,  indirect;  their 
main  agency  being  exerted  on  the  nervous  and  sanguiferous  sys- 
tems, which  they  depress. 

The  action  of  diaphoretics  is  aided  by  the  free  use  of  diluents; 
but  much  of  their  operation  is  to  be  referred  rather  to  the  tempera- 
ture of  the  fluid,  than  to  their  passing  into  the  blood-vessels,  and 
producing  polycemia.  The  experiments  of  Magendie  have  shown. 


308 


SPECIAL  DIAPHORETICS. 


that  if  warm  fluids  be  injected  into  the  veins  of  an  animal,  a state 
of  artificial  polysemia  may  be  induced,  during  the  existence  of 
which,  the  pulmonary  and  cutaneous  transpirations  are  greatly  in- 
creased. Where,  however,  there  is  much  erethism  present,  absorp- 
tion is  but  feebly  effected.  Were  it  otherwise,  inflammatory  diseases 
could  hardly  fail  to  be  largely  augmented  by  the  free  use  of  diluents. 

On  the  whole,  then,  even  in  febrile  and  inflammatory  affections, 
the  use  of  the  ordinary  internal  diaphoretics  is  uncertain,  and  gene- 
rally of  no  avail  ; whilst  several  of  them  are  decidedly  injurious  by 
their  excitant  properties ; yet,  in  many  such  cases,  advantage  may 
be  derived  from  the  equalising  influence  of  the  warm  bath ; and,  in 
minor  inflammations,  especially  of  the  gastro-pulmonary  mucous 
membrane  — as  catarrh  — the  good  effect  of  warm  diluents,  aided 
by  the  warmth  and  quietude  of  bed,  produce  an  effect  of  equalisa- 
tion, which  is  often  most  salutary.  In  no  disease,  perhaps,  has  the 
class  of  medicines,  which  we  are  considering,  been  more  extensively 
employed  than  in  rheumatism.  Its  pathology  has  always  been  con- 
nected with  suppression  of  perspiration.  Its  very  name,  indeed,  de- 
notes a rheum,  a defluxion  of  catarrh,  directed  to  the  part  labouring 
under  it,  and  the  cause  of  such  defluxion  has  been  almost  always 
referred  to  some  check  given  to  the  cutaneous  transpiration.  This 
applies  more  especially  to  chronic  rheumatism,  but  the  reasoning, 
and  the  practice  founded  upon  it,  have  been  extended  to  the  acute 
forms  of  rheumatism  or  rheumatic  fever,  in  which  the  copious  exu- 
dation from  the  cutaneous  exhalants,  notwithstanding  the  hot  skin, 
is  one  of  the  most  striking  symptoms.  Dover’s  powder  has  long 
been  a favourite  remedy  in  this  disease,  and,  when  given  in  proper 
doses,  it  is  often  useful,  for  the  reasons  previously  assigned.  The 
combination  is  well  adapted  for  diminishing  vascular  and  nervous 
action  ; but  the  indication,  in  these  cases,  is  surely  not  to  restore 
suppressed  perspiration,  but  rather  to  diminish  the  singular  state  of 
erethism,  which  characterises  this  anomalous  phlegmasia. 

In  almost  all  cases,  in  which  the  employment  of  diaphoretics  ap- 
pears to  be  indicated,  the  class  of  sedatives,  or  refrigerants,  or  both, 
will  be  found  infinitely  more  advantageous,  for  reasons  already 
assigned,  and  to  be  more  particularly  expatiated  upon,  when  the 
modus  operandi  of  those  divisions  of  remedial  agents  comes  to  be 
considered. 


SPECIAL  DIAPHORETICS. 

I.  Sedative  Diaphoretics. 

1.  ANTIMO'NIALS. 

The  preparations  of  antimony,  that  are.  alone  used  as  diapho- 
retics at  the  present  day,  are  the  tartrate  of  antimony  and  potassa ; 
the  pulvis  antimo7iialiSj  and  i\\Q  precipitated  snlphuret  of  antwiony. 


ANTIMONII  ET  POTASSiE  TARTRAS. 


309 


a.  ANTIMo'nII  ET  POXAs'siE  TARTRAS. TARTRATE  of  AN^TIMONY  AND 

POTAS'SA. 

Tartar  emetic  has  been  regarded  by  many  as  the  most  certain  of 
the  antimonial  diaphoretics,  and  it  is  assuredly  more  frequently  given 
than  any  other.  When  pushed  to  the  extent  of  inducing  nausea  — 
like  other  nauseant  emetics,  it  is  a true  and  valuable  sedative,  yet 
it  is  most  frequently  given  in  fever  so  as  to  produce  a febrifuge  effect 
without  exciting  nausea.  In  such  case,  as  already  remarked,  it  is 
an  uncertain  remedy,  and  nothing  exhibits  this  more  strongly  than 
the  discordant  testimony  in  regard  to  it  in  continued  fever  : whilst 
many  writers  consider  it  to  be  of  great  service,  others  speak  slight- 
ingly of  it.  ‘‘  Of  all  the  numberless  febrile  diseases,”  says  a recent 
writer,  Dr.  Christison,  “ where  antimonial  diaphoretics  are  preva- 
lently given,  the  only  one  where  my  own  observation  does  not  con- 
cur with  that  of  most  others  as  to  their  beneficial  effects  is  con- 
tinued fever.  After  extensive  experience  as  an  hospital  physician 
for  twenty  years,  I must  say,  that  I have  seen  no  substantial  rea- 
son for  the  warm  commendations  of  this  method  of  cure  by  some, 
either  in  the  marked  inflammatory  type  put  on  by  the  disease  in  the 
earlier  periods,  or  in  the  late  typhoid  form  which  it  has  assumed, 
or  in  the  synochous  form  in  which  it  appeared  in  the  middle  of 
the  term.  What  may  have  been,  or  may  yet  be,  the  case  of  other 
epidemics,  it  must  be  left  to  others  to  determine.  In  the  late  epi- 
demics of  Edinburgh  I have  seen  no  good  done  by  it  except  as  a 
palliative,  and  not  a very  trusty  one,  in  abating  reaction  in  the  early 
stages  of  synochus  and  typhus.” 

The  ordinary  dose  of  tartar  emetic  as  a diaphoretic  is  from  one- 
sixteenth  to  one-sixth  of  a grain  given  in  solution,  or  in  powder. 
By  many,  in  this  country,  a combination  of  nitrate  of  potassa, 
calomel  and  tartar  emetic  is  prescribed  under  the  name  of  “ JXitrous 
powders y The  usual  form  of  the  preparation  of  these  powders  is 
the  following.  [Antim.  et  potass,  tartr.  gr.  ^ ; Potasses  nitrat.  gss  ; 
Hydrarg.  chlorid.  mit.  gr.  J ad  gr.  J.  M.  One  of  these  to  be  given 
every  two  or  three  hours.)  They  are  especially  useful,  where  it  is 
desirable  to  touch  the  mouth  in  fever  ; yet  it  may  be  a question, 
whether  there  be  any  advantage  from  the  reputed  diaphoretics 
with  which  the  mild  chloride  of  mercury  is  combined.  In  the  ad- 
vanced stages  of  typhus,  accompanied  with  high  encephalic  excite- 
ment as  manifested  by  loss  of  sleep,  delirium,  &c.,  good  effects 
have  resulted  from  the  use  of  tartrate  combined  with  opium  ; yet 
these  are  precisely  such  cases  as  are  benefited  by  the  use  of  opium 
singly,  and  it  has  been  found  equally  beneficial  in  encephalic  dis- 
turbance supervening  on  other  diseases,  and  associated  with  ady- 
namic phenomena. 

VmUM  ANTIMO'NII,  ANTIMO'NLll  MNE.  The  dose  of  this  solution  of  the 
tartrate  of  antimony  and  potassa  as  a diaphoretic  is  from  ten  to  thirty 


310 


SPECIAL  DIAPHORETICS. 


drops,  repeated  three  or  four  times  in  the  course  of  the  day.  Each 
ounce  of  the  wine  contains  two  grains  of  the  tartrate. 

6.  puLvis  antimonia'lis.  — antimo'nial  powder. 

Dr.  James,  of  London,  about  the  middle  of  the  last  century  ac- 
quired great  celebrity  for  a powder  which  was  known  under  the 
name  of  Jameses  Powder.  This,  on  analysis,  was  found  to  consist 
of  phosphate  of  lime,  with  about  an  equal  .quantity  of  oxide  of  an- 
timony. In  accordance  with  this  analysis,  a preparation  was  intro- 
duced into  the  London  Pharmacopoeia,  which  resembles  in  its  in- 
gredients the  real  James’s  powder,  but  differs  in  their  proportion. 
The  London  Pharmacopoeia  has  the  following  directions  for  its 
preparation. 

Take  of  Sesquisulphuret  of  antimony^  in  powder,  a pound  ; Horn 
shavings,  two  pounds  : mix  and  throw  them  into  a red-hot  crucible, 
and  stir  constantly  until  vapour  ceases  to  arise.  Rub  the  residue 
to  powder,  and  put  it  into  a proper  crucible.  Then  apply  heat  raised 
gradually  to  redness,  and  keep  it  so  for  two  hours.  Rub  the  residue 
into  a very  fine  powder. 

By  this  process  the  animal  matter  of  the  horn  is  burnt  away,  and 
the  subphosphate,  with  a little  of  the  carbonate  of  lime,  is  left.  The 
sulphur  of  the  sesquisulphuret  is  expelled  by  the  same  agency  in  the 
form  of  sulphurous  acid,  whilst  the  antimony  takes  oxygen  from  the 
air,  forming  antimonious  acid,  and  sesquioxide  of  antimony.  The 
main  constituents,  therefore,  are  antimonious  acid  and  subphosphate 
of  lime.  It  is  of  a white  colour,  tasteless,  and  devoid  of  odour. 

Antimonial  powder  is  extremely  uncertain,  as  already  remarked, 
(p.  305,)  in  its  operation,  and  is  generally  wholly  inert ; for  these 
and  other  reasons  it  has  not  been  received  into  either  of  the  two 
last  editions  of  the  Pharmacopceia  of  the  United  States. 

Its  ordinary  dose  is  from  three  to  ten  grains  and  more,  repeated 
three  or  four  times  in  the  course  of  the  day.  It  may  be  given  in 
pill,  or  sugar  and  water. 

Some  practitioners  have  more  confidence  in  the  quack  “James’s 
powder;”  but  it,  also,  is  exceedingly  uncertain  in  its  operation  ; and 
accordingly  neither  the  one  nor  the  other  is  much  used  in  this 
country. 

C.  ANTIMO'nII  SULPHURe'tUM  PRA^CIPITA'tUM.  PRECIPITATED  SUL^- 

PHURET  OF  An'tIMONY. 

The  mode  of  forming  this  preparation,  in  the  British  Pharmaco- 
poeias and  in  that  of  the  United  States,  consists  in  boiling  sulphuret 
of  antimony,  and  solution  of  potassa  in  distilled  water  for  three  hours, 
constantly  stirring,  and  occasionally  adding  distilled  water,  so  as  to 
preserve  the  same  measure.  The  liquor  is  then  strained,  and,  while 
hot,  diluted  sulphuric  acid  is  dropped  in,  so  long  as  it  produces  a 
precipitate ; the  sulphate  of  potassa  formed  is  then  washed  away 


IPECACUANHA. 


311 


with  hot  water,  and  the  precipitated  sulphuret  of  antimony  is  dried 
and  rubbed  into  fine  powder. 

Several  old  antimonial  preparations  were  at  one  time  largely  em- 
ployed ; one  of  these  was  Kermes  mineral.  It  is  formed  by  boiling 
sesquisulphuret  of  antimony  in  an  alkaline  liquid,  and  allowing  a 
reddish  powder, — kermes  mineral,  — to  be  deposited  on  cooling. 
If  to  the  filtered  mother  liquor,  a dilute  mineral  acid  be  now  added, 
the  GOLDEN  SULPHURET  OF  ANTIMONY  — an  orange-red  precipitate  — 
is  thrown  down  ; and  if  the  acid  be  added  before  the  kermes  mine- 
ral has  subsided,  an  orange-red  precipitate  is  deposited,  which  is  the 
OXYSULPHURET  OF  ANTIMONY  of  the  London  Pharmacopoeia,  — the 
GOLDEN  SULPHURET  OF  ANTIMONY  of  the  Edinburgh,  and  the  preci- 
pitated SULPHURET  OF  ANTIMONY  of  the  United  States  Pharmaco- 
poeia. This  substance  is  insoluble,  devoid  of  smell,  and  of  a slightly 
styptic  taste.  It  is  insoluble  in  w^ater,  but  is  wholly  soluble  in  nitro- 
chlorohydric  acid,  with  the  evolution  of  hydrosulphuric  acid. 

Precipitated  sulphuret  of  antimony  is  not  inert.  It  has,  indeed, 
been  given  as  an  emetic,  but,  like  the  Pulvis  antimonialis,  is  so  un- 
certain in  its  operation,  that  it  is  rarely  used.  It  was  an  ingredient 
in  Plummer'’s  Pill^  and  is  therefore  still  retained  in  the  Pilulce  Hy- 
drargyri  Chloridi  Com,positcB  of  the  British  Pharmacopoeias.  The 
dose  as  a diaphoretic  is  from  two  grains  to  ten,  repeated  once  or 
oftener  in  the  day. 

2.  IPECACUAN'HA, 

The  remarks,  made  in  regard  to  the  tartrate  of  antimony  and  po- 
tassa  as  a diaphoretic,  are  equally  applicable  to  the  article  now 
under  consideration.  When  given  alone,  it  is  an  extremely  uncer- 
tain remedy  ; but  when  carried  to  the  extent  of  inducing  nausea,  it 
is  a valuable  sedative,  and,  by  allaying  the  excited  organic  actions, 
produces  indirectly  diaphoresis  in  febrile®and  inflammatory  diseases. 
It  is  often,  however,  administered  in  such  cases  in  so  small  a dose 
as  to  exert  probably  no  action  whatever,  whilst  at  the  same  time, 
the  disease  is  treated  upon  general  principles,  and  successfully. 

The  dose  of  powdered  Ipecacuanha  as  a diaphoretic  is  from  half 
a grain  to  a grain  ; wdth  such  view,  however,  it  is  most  commonly 
prescribed  in  conjunction  with  opium,  as  in  the  officinal  prepara- 
tion : — 

PLTOS  {PEfACUAN'ffiE  ET.  O'PII,  ‘POWDER  OF  IPECACUAN'HA  AND  O'PIUM. 
(//;ecac.pulv.  ; Opii,  pulv.  aa  ; Potasses  Sulphat.  Jj.)  This  is 
known  in  the  shops  as  DovePs  poioder,  being  an  imitation  of  a well 
known  formula,  already  referred  to,  which  was  used  by  Dover  as  a 
diaphoretic.  The  sulphate  of  potassa  probably  exerts  little  if  any 
action  on  the  economy.  It  serves  a useful  pharmaceutical  purpose, 
by  virtue  of  its  hardness,  — enabling  the  other  ingredients  to  be 
minutely  divided.  Of  the  modus  operandi  of  this  compound  pow- 
der, the  author  has  already  spoken  (p.  305).  It  is  very  much  used 


312 


SPECIAL  DIAPHORETICS. 


by  many  practitioners,  and  is  doubtless  often  given  in  cases  for 
which  it  is  by  no  means  appropriate.  It  is  best  adapted  for  those 
in  which  the  concentration  of  vital  activity  in  some  internal  organ  is 
not  excessive  ; and  where  the  indication  appears  to  be  — to  allay 
inordinate  action  and  to  procure  rest.  Hence,  a full  dose  in  adyna- 
mic and  ataxic  fever  is  often  very  beneficial ; at  the  commence- 
ment, too,  of  minor  inflammations,  as  catarrh,  sore-throat,  &c.,  when 
aided  by  diluents,  it  exerts  an  equalising  agency,  inducing  general 
diaphoresis,  and,  in  this  manner,  breaks  in  upon  the  hypereemia.  In 
cases  of  acute  rheumatism,  it  is  freely  exhibited,  and  some  trust  to  it 
entirely  throughout  that  painful  malady.  It  must  be  borne  in  mind, 
however,  that  acute  rheumatism  is  generally  a self-limited  disease, 
— running  its  course  with  but  little  modification  from  the  remedies 
ordinarily  prescribed  ; and  when  the  Pulvis  Ipecacuanha  et  Opii 
seems  to  be  beneficial,  it  is  less,  perhaps,  from  its  diaphoretic,  than 
soothing  agency  on  the  nervous  system,  which  is  so  much  impli- 
cated in  that  singular  aflection. 

It  must  be  borne  in  mind,  that  when  given  in  a large  dose,  the 
ipecacuanha  may  occasion  vomiting  ; and  hence  it  will  rarely  be  re- 
tained where  nausea,  or  a tendency  to  it,  exists.  For  the  same  reason, 
diluents  which  greatly  promote  its  action,  and  which  are  themselves 
diaphoretic  under  certain  circumstances,  cannot  be  freely  adminis- 
tered soon  after  a full  dose  of  the  powder  has  been  taken.  Where, 
for  example,  ten  grains  of  the  powder  have  been  administered  at 
bed-time  to  induce  diaphoresis,  as  in  an  ordinary  case* of  catarrh,  it 
may  be  well  to  wait  an  hour,  and  then  to  give  warm  wine  whey,  or 
a more  simple  diluent,  — as  tea  or  gruel. 

The  ordinary  dose  of  the  pulvis  ipecacuanhse  et  opii  is  ten  grains  ; 
which  may  be  repeated  in  the  course  of  three  or  four  hours.  Tea  or 
sugared  water  may  be  the  vehicle.  Ten  grains  contain  one  of  opium 
and  one  of  ipecacuanha ; but  the  former  is  probably  the  most  im- 
portant constituent. 

VHUMIPECACUAN'IIT,  WINE  OF  IPECACUANHA,  (p.  120.)  The  dose  of  this 
officinal  preparation,  as  a diaphoretic,  is  from  ir^x  to  f.  2ss  ; and  it  not 
unfrequently  forms  part  of  diaphoretic  mixtures,  prescribed  in  febrile 
and  inflammatory  affections.  When  associated  with  the  tincture 
or  wine  of  opium,  its  action  resembles  that  of  the  preparation  last 
described. 

3.  O'PIUM. 

The  effects  of  this  valuable  drug  on  the  nervous  system  generally 
are  explained  under  Narcotics.  On  the  nerves  of  the  skin,  its 
agency  is  shown  by  a sense  of  itching  or  pricking  over  the  surface 
of  the  body,  and  occasionally  by  a cutaneous  eruption.  When 
taken  in  very  large  sedative  doses,  all  its  preparations  — but  espe- 
cially those  of  morphia  — according  to  the  author’s  experience,  in- 
duce diaphoresis  ; and  where  opium  has  been  taken  for  the  purpose  of 


AMMONIiE  CARBONAS. 


313 


destroying  life,  the  perspiration  induced  by  it  has  been,  at  times,  ex- 
cessive. In  a fatal  case,  the  sheets  of  the  bed  were  completely 
soaked  to  a considerable  distance  round  the  body.  — (Christison). 

The  effects  of  opium  on  the  general  system  ■ — as  elsewhere  shown 
— are  altogether  relative,  and  dependent  upon  the  dose.  In  a small 
dose,  it  is  excitant ; in  a large  dose,  sedative ; and,  accordingly, 
there  are  pathological  conditions  in  which  good  effects  might  result 
from  it  in  a large  dose,  whilst  the  same  morbid  condition  might  be 
aggravated  by  a smaller  dose.  For  example,  in  febrile  and  inflam- 
matory cases,  a small  dose  might  add  to  the  existing  evil,  and 
render  the  skin  more  hot  and  dry,  whilst  a larger  dose  might  reduce 
the  organic  actions,  and  thus  prove  indirectly  diaphoretic.  The 
reader  is,  however,  referred  to  another  part  of  this  work  for  a farther 
exposition  of  these  views,  the  accuracy  of  which  has  been  recently 
admitted  by  Dr.  Spillan. 

Opium  is  rarely,  however,  administered  alone  as  a diaphoretic.  It 
is  generally  combined  with  ipecacuanha,  or  tartrate  of  antimony 
and  potassa.  See  Pulvis  Ipecacuanha  et  Opii,  (p.  311). 

II.  Excitant  Diaphoretics. 

4.  LIQUOR  AMMO'NI/E  ACETA/TIS.  — SOLU'TION  OF  AC"ETATE  OF 

AMMO'NIA. 

Solution  of  acetate  of  ammonia,  formerly  called  Spirit  of  Minde- 
re'ruSj  is  best  prepared  by  saturating  diluted  acetic  acid  with  carbonate 
of  ammonia.  If  quite  neutral,  it  produces  no  effect  either  on  tur- 
meric or  on  litmus  paper  : when  pure,  it  is  entirely  colourless. 

Difference  of  sentiment  has  existed  amongst  observers  in  regard  to 
this  solution,  as  to  whether  it  be  excitant  or  sedative  ; nor  is  the  dif- 
ference confined  to  this  point.  Whilst  some  have  the  greatest  con- 
fidence in  it  as  a febrifuge,  others  consider  it  to  be  devoid  of  action 
on  the  economy.  Four  ounces  were  taken  at  once,  and,  soon  after- 
wards, four  ounces  more,  without  any  sensible  effect. 

This  is  one  of  the  articles,  which  the  author  sometimes  prescribes 
in  fever,  but  more  from  its  serving  a temporising  purpose,  than  for 
any  marked  febrifuge  power  which  he  considers  it  to  possess.  It  is 
often  prescribed’  in  other  diseases  of  excitement,  sometimes  alone, 
but  frequently  along  with  antimonials,  nitrate  of  potassa,  &c.  As  in 
the  case  of  other  diaphoretics,  its  action  may  be  promoted  by  the  use 
of  diluents,  and  by  external  warmth. 

The  ordinary  dose  is  from  f.  Jss  to  Jiss,  which  may  be  repeated 
four  or  five  times  in  the  day. 

5.  AMMO'NI^  CAR/BONAS.  — CAR'BONATE  OF  AMMO'NIA. 

Carbonate  of  ammonia  — as  elsewhere  stated  — is  an  active  ex- 
citant ; and,  like  other  excitants,  proves  diaphoretic  under  certain 
circumstances.  It  is  rarely,  however,  given  as  a diaphoretic  alone, 
and  not  often  in  combination.  Associated  with  opium,  it  is  occa- 
sionally prescribed  in  protracted  ataxic  and  adynamic  fevers ; and 
VOL.  I. — 27 


314 


SPECIAL  DIAPHORETICS* 


in  acute  rheumatism,  it  has  been  given  by  some  in  association  ■with 
guaiac,  but  on  no  very  rational  principle  : accordingly,  at  the  pre- 
sent day,  it  is  by  no  means  frequently  used.  It  is  recommended, 
that  its  diaphoretic  operation  should  be  assisted  by  diluents  and 
warm  clothing,  which  are  themselves  diaphoretic  agents. 

The  dose  as  a diaphoretic  is  from  gr.  x to  9j  ; and  a good  vehicle 
for  its  administration  is  almond  emulsion.  Sugared  water  answers, 
however,  every  purpose. 

Liquor  ammonia:  or  Solution  of  ammonia,  is  administered  by 
some  as  a diaphoretic,  under  the  same  circumstances  as  carbonate  of 
ammonia.  The  dose  is  i^liv  to  iR.xx,  in  sugared  water,  or  properly 
diluted. 

Citrate  of  ammonia.  Ammonia:  citras,  which  is  commonly  pre- 
pared by  saturating  the  ammonia  of  the  carbonate  of  ammonia  with 
fresh  lemon-juice,  is  occasionally  used  as  a diaphoretic  both  in  the 
still  and  effervescent  state. 

6.  EUPATO'RIUM.  — THOR'OUGHWORT. 

Thoroughwort  or  Boneset,  Sex.  Syst.  Syngenesia  iEqualis ; 

Nat.  Ord.  Com- 
positae  Corymbi- 
ferae,  is  an  indige- 
nous plant,  com- 
mon in  almost  all 
■parts  of  the  United 
States  ; 
moist  p 

flowering  from  the 
middle  of  summer 
to  the  close  of  Oc- 
tober. The  tops 
and  leaves  are  offi- 
cinal in  the  Phar- 
macopoeia of  the 
United  States. 

No  analysis  has 
been  made  of  it ; 
but  its  medical 
virtues,  which  ap- 
pear from  the  taste 
to  consist  in  part 
of  bitter  extrac- 
tive, are  commu- 
nicated to  water 
and  to  alcohol. 

The  virtues  of 
eupatorium  as  a 
diaphoretic  are  esteemed  by  some  to  be  very  powerful,  and  to  suc- 


inhabiting 
aces,  and 


POTASS/E  CITRAS. 


315 


ceed  when  other  excitant  diaphoretics  have  failed.  Hence  it  has 
been  given  freely  in  acute  and  chronic  rheumatism.  The  tonic 
properties,  which  it  possesses  at  the  same  time,  render  it  especially 
adapted  for  cases  in  which  a diaphoretic  and  tonic  influence  is  de- 
manded. In  very  large  doses  it  may  prove  emetic. 

As  a diaphoretic,  it  is  rarely  given  in  substance.  The  ordinary 
dose  of  the  powder  is  from  to  55s.  The  infusion  is  generally 
prescribed. 

INFU'SUM  EUPATO'RII,  INFU'SION  OF  THOR'OUGHWORT.  {Eupator.  §j  ; Aq. 
hullient,  Oj.)  This  should  be  taken  warm,  and  freely,  the  patient 
remaining  in  bed.  It  has  been  recently  very  strongly  recommended  by 
Dr.  Peebles,  of  Petersburg,  Virginia,  in  influenza,  — given  so  as  to 
keep  up  a nauseant  effect  on  the  system. 

Eupatorium  Teucrifolium,  or  Wild  Horehoundj  — which  grows 
in  low  wet  places,  is  especially  abundant  in  the  Southern  states, 
and  flowers  from  August  to  November, — possesses  similar  virtues 
with  E.  Perfoliatum.  The  whole  herb  was  formerly  officinal  in  the 
secondary  list  of  the  Pharmacopoeia  of  the  United  States. 

7.  SPIR'ITUS  ^'THERIS  KFTRICL  — SPIRIT  OF  NITRIC  ETHER. 

This  preparation,  whose  general  properties  are  given  elsewhere 
(p.  273)  — has  been  described  as  possessing  the  ordinary  excitant 
properties  of  the  ethers  and  alcohol.  It  may,  consequently,  prove 
diaphoretic,  and  be  beneficial  in  fevers  of^he  adynamic  kind.  It 
is  not  so  easy  to  see  how  it  can  be  refrigerant,  although  it  is  so  re- 
garded by  many.  There  is,  indeed,  no  single  article  in  the  cata- 
logue of  the  Materia  Medica,  which  is  more  frequently  prescribed 
by  the  routinist  in  febrile  cases  in  general.  Fortunately,  it  is  never 
given  in  large  quantities,  and,  therefore,  not  much  harm  results ; yet 
it  is  difficult  to  see  how  it  can  be  appropriate  where  the  vascular  ac- 
tion is  excessive  as  in  our  ordinary  febrile  and  inflammatory  affec- 
tions. By  many  it  is  associated  with  the  liquor  ammonise  acetatis  ; 
by  others  with  antimonials  — the  latter  not  being  a very  philosophi- 
cal combination,  as  one  of  the  diaphoretics  is  excitant,  the  other 
sedative.  With  more  propriety  it  has  been  advised  in  combination 
with  a small  quantity  of  compound  spirit  of  ammonia,  and  pre- 
scribed in  the  low  stage  of  fevers.  Often,  perhaps,  — especially 
in  the  febrile  affections  of  children,  — it  is  prescribed  in  the  dose  of 
a few  drops,  without  the  practitioner  having  much,  if  any,  confi- 
dence in  its  diaphoretic  powers,  but  where  it  is  necessary  to  do 
something. 

The  dose  of  the  spirit  of  nitric  ether,  as  a diaphoretic,  is  f.  ^ss 
to  f.  gij,  in  water. 

8.  POTAS'SH3  CITRAS.  — CITRATE  OF  POTAS^SA. 

Citrate  of  potassa  is  never  kept  in  the  shops.  It  is  readily  made 
by  saturating  the  potassa  of  carbonate  of  potassa  with  citric  acid  ; 


316 


SPECIAL  DIAPHORETICS. 


but  the  salt  is  deliquescent,  and  crystallises  with  difficulty.  A solu- 
tion of  it  is  very  frequently  formed  extemporaneously  ; and  the 
Pharmacopoeia  of  the  United  States,  for  1S42,  contains  two  formulae 
for  the 

LlffiJOR  POTAS'SJl  CITRA'TIS,  or  SOLU  TION  OF  CITRATE  OF  POTAS'SA;  the 
one  made  with  fresh  lemon-juice,  and  the  other  with  citric  acid. 
{ Succ.  limon.  recent.  Oss ; Potasses  carhonat.  q.  s.  ; or.  Acid,  citric. 
^ss;  01.  limon.  ii^ij  ; Aques  Oss;  Potasses  carhonat.  q.  s.) 

These  formulae  are  properly,  perhaps,  introduced,  seeing  that  the 
mixture  is  so  often  prescribed,  in  order  that  uniformity  may  be  ob- 
served in  its  preparation.  It  is  the  well  known  neutral  mixture., 
which,  in  one  form  or  other,  has  been  employed  in  febrile  cases  for 
ages.  When  properly  prepared,  it  is  merely  a solution  of  neutral 
citrate  of  potassa  flavoured  with  lemon-peel,  and  has  no  more  dia- 
phoretic virtue  than  a similar  solution  of  any  of  the  neutral  salts. 
Yet  it  is  constantly  administered  in  febrile  cases,  and  as  these  gene- 
rally do  well  under  the  observance  of  a course,  which  avoids  all  un- 
necessary irritation,  and  removes,  as  far  as  possible,  disturbing  in- 
fluences when  they  occur,  a portion  of  the  good  effects  is  very  apt 
to  be  ascribed  to  any  agent  which  is  administered  at  the  same  time. 
The  neutral  mixture  or  saline  mixture.,  as  it  has  been  likewise  called, 
has  been  extensively  used  by  the  author  ; but  he  has  long  abandoned 
its  employment,  except  where  it  was  necessary  to  carry  out  a tem- 
porising method  of  treatment ; and  in  these  very  cases,  it  is  much 
preferable  to  give  the  mixture  in  a state  of  effervescence,  in  order 
that  the  gently  excitant  influence  of  the  carbonic  acid  may  be  ex- 
erted on  the  stomach.  Still,  for  this  purpose,  the  use  of  the  mineral 
water  or  soda  water  of  the  shops  is  to  be  preferred.  When  kept 
cold  — ice  cold — it  is  an  admirable  refrigerant,  and  exceedingly 
grateful,  much  more  so  than  the  neutral  mixture,  no  matter  how  well 
the  latter  may  be  prepared.  The  author  has,  however,  elsewhere 
described  his  views  in  regard  to  the  agency  of  Refrigerants  in 
febrile  and  inflammatory  affections. 

9.  CAMTHORA.  — CAMPHOR. 

Camphor — whose  general  properties  are  described  under  Ex- 
citants— by  virtue  of  its  excitant  powers  is  diaphoretic;  yet  it  is 
rarely  given  alone.  Combined  with  antimonials,  as  the  tartrate  of 
antimony  and  potassa,  it  is  prescribed  occasionally  in  fevers  of  the 
adynamic  kind ; yet  the  combination  seems  scarcely  to  be  philoso- 
phical, inasmuch  as  one  article  is  diaphoretic  by  virtue  of  its  exci- 
tant, the  other  by  virtue  of  its  sedative,  agency.  It  has  been  else- 
where shown,  that  in  long  protracted  fevers  of  the  adynamic  and 
ataxic  kind,  it  is  often  associated  with  opium. 

The  ordinary  dose  of  camphor  as  an  excitant  diaphoretic  is  ten 
grains,  given  in  the  form  of  pill  or  emulsion.  Its  officinal  prepara- 
tions are  scarcely  ever  prescribed  as  diaphoretics. 


GUAIACUM. 


317 


10.  GUAl'ACUM.  — GUAI'AC. 

Both  the  wood  of  the  Guai'acum  officina'le  — Guai'aci  Lignum, 
and  the  concrete  juice  — Guai'aci  Resi'na,  Guai'ac  — are  officinal 
in  the  Pharmacopoeias  of  Great  Britain  and  this  country.  They  have, 
indeed,  been  employed  in  Europe,  where  they  were  introduced  by 
the  Spaniards  soon  after  the  discovery  of  the  New  World. 

Guaiacum  officinale;  Sex.  Syst.  Decandria  Monogynia ; Nat. 
Ord.  Zygophyllaceae,  (Bindley,)  is  a large  tree,  which  is  indige- 
nous in  the  West  Indies,  particularly  in  Saint  Domingo  and  Jamaica. 
On  the  continent  of  Europe,  the  bark  is  much  used,  and  it  appears 
to  contain  more  of  the  virtues  of  the  tree  than  the  wood. 

1.  GUAPACI  LIGNUM,  GUAI'ACUM  WOOD,  — is  Lignum  Vitce,  an  extraor- 
dinarily hard  and  tough  wood,  which  is  used  for  making  pestles, 
block-sheaves,  &c.  It  is  imported  in  logs  or  billets,  consisting  of  a 
broad  grayish-yellow  alburnum,  and  a dark  greenish-brown  or  green- 
ish-black duramen,  the  latter  of  which  is  the  denser  of  the  two.  The 
specific  gravity  of  the  whole  is  1.333,  so  that  it  sinks  in  water, 
Guaiac  wood  of  the  shops,  Rasu'ra  Guai'aci^  consists  of  the  turn- 
ings from  the  workshop  of  the  turner,  and  is  a mixture  of  both  albur- 
num and  duramen.  It  is  almost  devoid  of  smell,  unless  when  rub- 
bed, rasped  or  heated,  when  it  has  an  aromatic  odour.  It  excites  a 
bitter,  acrid  biting  taste  on  the  palate.  When  analysed  by  Tromms- 
dorff,  it  was  found  to  contain  26  per  cent,  of  resin  — probably  the 
guaiac,  to  be  described  presently,— with  a bitter  piquant  extractive 
matter,  which  was  most  abundant  in  the  alburnum ; the  resin  abound- 
ing in  the  central  wood  or  duramen.  The  central  wood  has  gene- 
rally been  preferred,  and  the  alburnum  has  even  been  directed  to  be 
discarded  by  some,  under  the  idea  that  its  activity  is  altogether  de 
pendent  upon  the  resin  it  contains.  This,  however,  as  has  been  re 
marked  by  a recent  pharmacologist.  Dr.  Christison,  is  a mistake 
and  even  if  we  were  not  to  accord  with  him,  that  the  more  acrid 
alburnum  ought,  perhaps,  to  be  preferred,  we  might  still  object  to  the 
rejection  of  the  acrid  principle. 

Guaiacum  yields  its  virtues  to  both  alcohol  and  water,  but  not 
equally  well  to  both.  The  resinous  matter  is,  of  course,  not  wholly 
imparted  to  the  latter.  Alcohol  has  been  found  to  dissolve  21  per 
cent.  ; boiling  water  10  per  cent,  according  to  one  experimenter  ; 
17,  according  to  another;  — yet,  the  most  favourite  preparations  of 
guaiacum  wood  have  been  at  ail  times  decoctions  ; which  would  rather 
favour  the  idea,  that  the  activity  may  be  greatly  resident  in  the  acrid 
principle. 

Guaiacum  wood  is  an  excitant  diaphoretic,  less  perhaps  on  ac- 
count of  the  acrid  extractive  which  it  contains  than  of  the  resin,  which 
is  nearly  insoluble  in  water.  It  is  rarely,  however,  administered  as 
a diaphoretic.  It  has  been  given  in  chronic  rheumatism  in  the  form 
of  decoction  ; and  has  frequently  been  prescribed  — as  will  be  seen 
elsewhere  — as  a eutrophic,  in  diseases  of  the  system  of  nutritionj  as 
27* 


318 


SPECIAL  DIAPHORETICS. 


in  scrofulous,  syphilitic  and  syphiloid  afTections.  Where  the  ac- 
tive excitant  properties  of  guaiacum  are  wanted,  the  resin  is  almost 
always  directed. 

A simple  decoction  of  guaiacum  may  be  made  by  boiling  an  ounce 
of  the  shavings  or  turnings,  in  a pint  and  a half  of  water  down  to 
a pint.  To  produce  diaphoresis,  this  should  be  given  warm,  in  the 
dose  of  four  ounces  repeated  every  five  or  six  hours  if  necessary. 

Guaiacum  wood  is  an  ingredient  in  the  Decoctum  Sarsaparillce 
compositum^  and  the  Syrupus  SarsaparillcE  compositus  of  the  Phar- 
macopoeia of  the  United  States. 

2.  GUAFACI  RESIAA,  GUAI'AC,  or,  as  it  has  been  erroneously  called,  Gum 
guaiac^  is  an  exudation  from  the  tree,  spontaneously  or  by  means  of 
incisions.  It  is  obtained,  also,  by  taking  billets  of  the  wood,  boring 
a hole  lengthwise  through  them,  and  putting  one  end  in  the  fire  ; the 
the  other  being  so  placed,  that  the  melted  resin,  which  runs  through 
the  hole  as  the  wood  bums^  may  be  received  into  a calabash.  This 
appears  to  be  the  process  usually  followed  ; but  it  is  likewise  ob- 
tained in  small  quantities  by  boiling  chips  or  sawings  of  the  wood 
in  salt  water,  when  the  resin  swims  on  the  top  and  may  be  skimmed 
off.  The  salt  is  added  to  raise  the  boiling  point  of  the  water. 

Guaiac,  as  found  in  the  shops,  is  usually  in  irregular  lumps,  often 
containing  chips  of  wood  and  other  impurities.  These  are  of  a brown- 
ish-red or  brownish-yellow  colour  at  the  surface,  when  fresh  ; but  they 
become  greenish  on  exposure  to  the  air.  The  fracture  is  brilliant  and 
resinous.  Its  specific  gravity  is  about  1.23.  When  rubbed,  it  has  a 
slight  balsamic  odour  ; with  little  taste,  but  leaves  a sense  of  heat 
and  pungency  in  the  mouth.  The  whole  of  the  resin  is  soluble  in 
alcohol  ; the  impurities  being  alone  left.  Water  dissolves  about  9 
per  cent.  ; and  the  solution  has  a sweetish  taste.  The  soluble 
matter  is  probably  the  extractive,  which  Brande  found  to  exist  in  it 
in  the  proportion  of  9 per  cent.  The  resin,  considered  by  some  to 
be  peculiar,  and  which  has  been  called  Gwa?'«cmand  Guai'acic  acid, 
forms,  according  to  the  same  analyst,  91  per  cent.  Ether  acts  less 
energetically  on  guaiac  than  alcohol,  and  the  fixed  and  volatile  oils 
scarcely  at  all.  This  last  circumstance  enables  an  adulteration, 
which  is  sometimes  practised  on  the  continent  of  Europe,  to  be  de- 
tected. The  resin  of  the  pine  or  colophony  is  coloured  green,  and 
mixed  with  it  ; and  the  adulteration  is  detected  by  the  partial  solu- 
bility of  the  suspected  article  in  hot  oil  of  turpentine,  which  djs- 
solvesthecolophony,  but  does  not  act  on  the  guaiac.  It  exhales,  also, 
a terebinthinate  odour  when  heated. 

Like  the  wood  of  guaiacum,  the  resin  is  possessed  of  excitant  pro- 
perties, and,  when  aided  by  warm  drinks  — the  patient  being  kept 
in  bed — ' it  proves  diaphoretic.  It  is  generally,  however,  associated 
with  nitrate  of  potassa,  ipecacuanha  and  opium,  or  antimonials  ; and 
is  most  frequently  prescribed  for  this  purpose  in  acute  rheumatism 
after  the  more  active  period  has  passed  away,  and  in  chronic  rheu- 


MEZEREUM. 


319 


matism.  In  such  cases  it  is,  at  times,  arbitrarily  combined  with  sul- 
phur. It  has  likewise  been  given,  on  account  of  its  excitant  proper- 
ties, in  chronic  atonic  gout. 

The  dose  of  the  powdered  guaiac  is  from  gr.  x to  ^ss,  given  in 
the  form  of  pill  or  bolus.  The  London  and  Edinburgh  Pharma- 
copceias  have  a Mistura  Guaiaci  or  Guaiacum  Mixture,  which,  ac- 
cording to  the  former,  is  composed  of  Guaiac,  ^iij  ; Sugar,  gss  ; 
Mucilage  of  gum  arabic,  f.  Jss ; Cinnamon  water,  f.  ^xix.  The 
guaiac  is  rubbed  with  the  sugar  ; then  with  the  mucilage  ; and  to 
these,  whilst  rubbing,  the  cinnamon  water  is  gradually  added.  The 
dose  is  f.  gss  to  f.  jij?  two  or  three  times  a day. 

TINCTU'RA  GUAl'ACI,  TINCTURE  OF  GUAUAC.  ( Guaiac.  pulv.  ibss  ; Alco- 
hol. Oij.)  This  tincture  is  not  unfrequently  given  in  the  rheumatic 
and  gouty  cases  referred  to  above.  When  mixed  with  water,  the 
guiacum  is  separated.  Still  it  may  be  taken  in  this  manner,  but  the 
best  plan  is  to  mix  the  tincture  with  mucilage  before  the  water  is 
added,  and  sweeten  with  sugar,  as  in  the  following  form  : — R*  Tinct. 
guaiac.  f.  ^vj  ; Mucilag.  acacice,  f.  ^ss  ; Aquce  cinnam.,  \Q?Aqucepur., 
f.  givss.  — M.  Dose,  a fourth  part  four  times  a day.  The  ordinary 
dose  of  the  tincture  of  guaiac  is  f.  5j.  to  f.  5iij. 

TINCTURA  GUAl'ACI  AMMONIA'TA,  AMMO'NIATED  TINCTURE  OF  GUAUAC. 
( Guaiac.  pulv.  Jiv  ; Spirit,  ammonice  aromat.  Oiss.)  In  conse- 
quence of  the  addition  of  the  aromatic  spirit  of  ammonia,  this  tinc- 
ture is,  of  course,  more  excitant  than  the  preceding.  It  is  applica- 
ble, however,  to  the  same  cases,  and  requires  the  same  admixtures 
as  the  simple  tincture.  The  dose  is  f.  5j  to  f.  jij. 

11.  MEZE'REUM.  — MEZE'KEON. 

The  mezereon  of  the  shops  is  the  bark  of  Daphne  meze'reum  and 
Daphne  gnid'ium;  Sex.  Syst.  Octandria  Monogynia  ; Nat.  Onq. 
Thymelaceae,  (Lindley.)  The  British  colleges  refer  it  entirely  to 
Daphne  mezereum.  Common  mezereum,  or  Spurge  Olive,  a shrub 
which  is  common  in  shady  woods  throughout  central  and  northern 
Europe,  as  well  as  in  the  northern  parts  of  Asia,  and  is  generally 
regarded  to  be  indigenous  in  Great  Britain.  Dr.  Christison,  how- 
ever, considers  it  a “ doubtful  native,”  of  that  country.  It  is  occa- 
sionally seen  in  the  gardens  of  this  country,  being  much  admired  for 
its  beautiful  fragrant  pink  flowers,  and  its  splendid  clustered  scarlet 
berries.  There  is  a variety,  however,  with  white  flowers,  and  with 
berries  of  a yellow  or  orange  colour.  It  flowers  from  February  to 
April  inclusive,  according  to  the  greater  or  less  temperature  of  the 
climate. 

In  England'  and  Scotland,  the  bark  of  the  root  is  alone  used; 
in  this  country,  the  bark  of  the  stem  is  recognised,  which  is  imported 
from  Germany.  It  appears  to  be  immaterial  which  is  employed  ; 
such,  at  least,  would  seem  to  be  the  opinion  of  the  framers  of  the 


320 


SPECIAL  DIAPHORETICS. 


Dul^lin  and  United  States  Pharmacopoeias.  Others,  however,  con- 
sider the  root  bark  to  be  more  active.  It  is  commonly  collected  in 
the  spring,  from  the  root,  where  the  root  bark  is  employed,  or  from 
the  bark  of  the  stem  and  larger  branches  — as  in  Germany  — when 
it  is  folded  into  small  bundles,  and  dried  for  medical  use.  As  we 
meet  with  it  in  the  shops,  it  is  in  strips  of  greater  or  less  length, 
folded  in  small  bundles.  It  is  tough,  pliable  and  fibrous,  of  a brown 
colour  externally,  and  white  and  cottony  within.  Its  taste  is  sweet- 
ish at  first,  but  this  is  soon  followed  by  great  acridity.-  It  has  no 
smell  when  dried,  but  when  fresh,  the  odour  is  faint  and  unpleasant. 

Mezereon  yields  its  virtues  to  water.  These  seem  to  be  refera- 
ble to  an  acrid  resin,  which  there  is  some  reason  to  suppose  is  a 
compound.of  an  acrid,  vesicating,  fixed  oil  and  another  substance, 
and  which  is  made  soluble  in  water  by  means  of  other  constituents 
of  the  bark. 

All  the  parts  of  the  mezereon  are  highly  acrid,  so  that  — as  else- 
where shown  — w^hen  they  are  applied  to  the  skin,  they  excite  irri- 
tation and  vesication.  When  taken  internally,  they  are,  therefore, 
powerfully  excitant,  and,  in  large  doses,  acrid  poisons. 

Like  guaiacum  wmod,  it  has  enjoyed  reputation  as  a eutrophic  or 
alterative  in  the  treatment  of  syphilitic  and  syphiloid  diseases,  and 
in  chronic  cutaneous  affections,  and  morbid  states  of  the  system  of 
nutrition  in  general.  Its  virtues  in  these  relations  are,  however, 
treated  of  in  another  place.  Like  guaiacum  wood,  again,  it  has 
been  given  in  rheumatism  and  gout  as  an  excitant  diaphoretic,  but 
it  is  not  much  employed.  A simple  decoction  of  mezereon  is  offi- 
cinal in  the  Edinburgh  and  Dublin  Pharmacopoeias.  It  is  prepared 
of  mezereon  hark^  in  chips,  5ij  ; liquorice  root^  bruised,  §ss  ; water^ 
Oij,  boiled  down  to  a pint  and  a half.  The  dose  of  this  in  chronic 
rheumatism  is  f.  ^iv  to  f.  §viij,  two  or  three  times  a day. 

Mezereon  is  an  ingredient  in  the  Decoctum  Sarsaparilla  composi- 
tum  of  the  Pharmacopoeia  of  the  United  States. 

12.  SASSAFRAS  RADFCIS  CORTEX.  — BARK  OF  SAS'SAFRAS  ROOT. 

This  drug — as  elsewhere  shown  — is  excitant  by  virtue  of  its  es- 
sential oil  ; and,  like  other  excitants,  may  — under  certain  circum- 
stances— prove  diaphoretic.  Dr.  Wood  remarks,  that  ‘‘  its  posses- 
sion of  any  peculiar  tendency  to  the  skin,  independently  of  its  more 
excitant  property,  is  quite  doubtful.”  This  would  apply  perhaps  to 
all  excitant  diaphoretics,  which  probably  act — as  the  author  has  en- 
deavoured to  show  — in  all  cases  indirectly. 

When  taken  in  the  form  of  hot  infusion  or  tea,  and  aided  by  the 
warmth  of  bed  and  warm  drinks,  this  drug  certainly  proves  diapho- 
retic, and  might,  therefore,  be  given  in  incipient  catarrhs,  and  in 
slight  local  inflammations,  with  advantage.  It  has,  likewise,  been 
prescribed  in  chronic  rheumatism  ; and  as  will  be  elsewhere  seen  — 
has  formed  part  of  diet-drinks  administered  in  syphilitic  and  other 
vices  of  the  system  of  nutrition.  It  is  an  ingredient  in  the  Decoctum 


ASCLEPIAS  TUBEROSA. 


321 


Sarsaparilla,  compositum  of  the  Pharmacopoeia  of  the  United  States; 
although  its  volatile  oil  cannot  fail  to  be  driven  off  during  the 
boiling. 

OIL  OF  SAS'SAFRAS,  O'LEUM  SAS'SAFRAS,  is  employed  in  the  same 
cases  as  sassafras  itself,  and  is  an  ingredient  in  the  Syrupus  Sar- 
saparilla compositus  of  the  Pharmacopoeia.  Its  dose  is  from  Tr\^ij  to 
rrix  on  sugar,  or  in  some  warm  fluid. 

13.  MELIS'SA.  — BALM. 

The  leaves  of  Melis'sa  officina'lis  or  Common  Balm  ; Sex.  Syst. 
Didynamia  Gymnospermia ; Nat.  Ord.  Labiatae — are  officinal  in 
the  secondary  list  of  the  Pharmacopoeia  of  the  United  States.  The 
plant  is  a native  of  the  south  of  France  ; but  has  been  introduced 
into  this  country,  where  it  is  cultivated  for  use  in  the  gardens.  The 
flowers  appear  in  July,  prior  to  which  the  plant  should  be  gathered. 

Balm  has  an  aromatic  bitter  taste,  and  a strong  peculiar  odour, 
which  is  preserved  by  the  dried  plant,  provided  the  desiccation  be 
accomplished  quickly  ; but  is  lost  in  time.  On  analysis,  it  yields 
volatile  oil,  which  resembles  in  smell  the  oil  of  lemons,  — resin, 
bitter  extractive  matter,  gum,  tannic  acid,  and  woody  fibre.  The 
volatile  oil  is  not  in  great  quantity.  The  leaves  yield  their  virtues 
to  hot  water. 

Infusion  of  Balm  or  Balm  Tea  is  stimulant  by  virtue  of  its  es- 
sential oil ; but  as  this  is  only  in  quantity  sufficient  to  afford  an 
agreeable  flavour  to  the  infusion,  it  cannot 'have  much  remedial 
agency.  In  domestic  practice,  when  given  hot,  it  has  been  es- 
teemed an  excitant  diaphoretic  ; but  the  effects  are  probably  refer- 
able to  the  hot  water.  The  author  has  often  seen  it  exhibited  ; and 
is  disposed  to  arrive  at  this  conclusion.  It  may  be  given  in  catar- 
rhal and  other  affections  in  which  a gentle  excitant  influence  on  the 
skin  is  considered  to  be  indicated. 

14.  ASCLE'PIAS  TUBERO'SA.  — BUT'TERFLY  WEED. 

The  root  of  ButHerfly  Weed,,  or  Pleu'risy  Root,  is  in  the  secondary 
list  of  the  Pharmacopoeia  of  the  United  States.  It  belongs,  in  the 
Sex.  Syst.,  to  Pentandria  Digynia  ; and  is  in  the  Nat.  Ord.  Ascle- 
piadeae.  This  species  of  Asclepias  flourishes  in  every  part  of  the 
United  States,  and  flowers  in  June  and  July  — the  flowers  being 
of  a beautiful  reddish  orange  colour.  It  is  especially  abundant  in 
the  Southern  states. 

The  root,  as  seen  in  the  shops,  is  large  and  irregularly  tuberous  ; 
of  a brown  colour  externally,  and  white  and  striated  within.  In 
its  fresh  state,  it  has  a nauseous  subacrid  taste.  Its  virtues  are  im- 
parted to  boiling  water. 

Asclepias  tuberosa  belongs,  doubtless,  to  the  class  of  excitant  dia- 
phoretics ; and,  in  large  doses,  is  said  to  be  cathartic.  It  has  been 
prescribed  in  catarrh,  and  in  inflammatory  affections  of  the  chest  in 


322 


SPECIAL  DIAPHORETICS. 


Fiop.  45. 


general,  especially  after  blood-letting  ; and,  in  consequence  of  its  fan- 
cied efficacy  in  pleu- 
risy, especially,  has 
received  one  of  its 
appellations. 

The  dose  of  the 
powdered  root  is  gr. 
XX  to  5i,  taken  three 
or  four  times  a day  ; 
but  this  is  not  the 
best  form  as  a dia- 
phoretic. The  de- 
coction or  infusion 
is  generally  employ- 
ed for  this  purpose  in 
the  proportion  of 
one  ounce  of  the 
root  to  a quart  of 
water,  the  dose  being 
a teacupful  every 
three  or  four  hours, 
taken  warm,  and  the 
patient  being  kept  in 
bed,  and  warm  dilu- 
ents allowed. 

15.  XANTHOX'YLUM. 
— PRICKLY  ASH. 

Xanthoxylum  is  the 
bark  of  Xantliox' yluin 
Fraxin'eum  ; Sex. 

Syst.  Dioecia  Pentandria  ; Nat.  Ord.  Terebinthacese,  — Xanthoxy- 
leae,  (Lindley,)a  native  of  the  United  States,  excepting  of  the  south- 
ern portion,  growing  in  woods  and  in  moist  shady  places  ; and  flow- 
ering in  April  and  May. 

The  bark,  as  met  with  in  the  shops,  is  in  quilled  pieces  with  an 
ash-coloured  epidermis  ; that  of  the  small  branches  having  strong 
prickles.  It  is  very  light  and  brittle  ; nearly  without  smell,  and  of 
a taste  sweetish  at  first,  and  slightly  aromatic,  and  afterwards  bit- 
terish and  acrid.  Its  virtues  are  communicated  in  part  to  boiling 
water.  On  analysis  by  Mr.  Staples  it  was  found  to  contain  volatile 
oil,  a greenish  fixed  oil,  and  resin,  as  its  chief  constituents. 

Xanthoxylum  belongs  obviously  to  the  class  of  excitant  diapho- 
retics, and  is  considered  to  resemble,  in  its  action,  mezereon  and 
guaiac.  It  has  been  administered  in  similar  cases,  and  is  said  by 
Ur.  Bigelow,  of  Boston,  to  enjoy  considerable  reputation  in  chronic 
rheumatism. 

The  dose  of  the  powder  is  gr.  x to  3ss,  given  three  or  four  times 


Asclepias  tuberosa. 


ARUM. 


323 


a day.  It  is  sometimes  directed  in  the  form  of  decoction  — an  ounce 
of  the  drug  being  boiled  in  three  pints  of  water  to  two  : a pint  of 
this  is  taken  in  divided  doses  during  the  day.  Boiling  can  scarcely 
fail,  however,  to  dispel  some  of  its  active  constituents,  and  therefore, 
cannot  be  a good  form  of  preparation. 

Xanthoxylum  is  in  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States. 


Besides  the  excitant  diaphoretics  already  described,  the  Pharma» 
copoeia  of  the  United  States  has  the  following  in  its  secondary  list. 

16.  Ara'lia  Spino'sa,  Angelica  Tree  Bark.  Ara'lia  Spino'sa. 
Angelica  Tree.,  Toothache  Tree.,  or  Prickly  Ash  ; Sex.  Syst.  Pentan- 
dria  Pentagynia  ; Nat.  Ord.  Araliacese,  is  an  indigenous  shrub, 
which  grows  chiefly  in  the  Southern  and  Western  states,  and  is  cul- 
tivated in  the  gardens  to  the  north  as  an  ornamental  plant.  It 
flowers  in  August  and  September. 

The  bark  is  generally  given  in  decoction,  [Aral,  spinos.  ; 
Agues  Oiss.  BoU  to  a 

pint..  Dose  f.  §iss  to  Fig*  46. 

f.  ^ij,  three  or  four  times 
a day,  in  chronic  rheu- 
matic cases. 

17.  Arum,  Dragon 
Rooty  Indian  Turnip,  is 
the  cormus  of  Arum 
Triphyllum,  Dragon 
Rooty  Indian  Turnip,  or 
Wake  Robin ; Sex.  Syst. 

Monoecia  Polyandria  ; 

Nat.  Ord.  Aroideee,  — 

Araceas,  (Bindley.)  The 
plant  is  indigenous  and 
common  in  the  United 
States,  and,  like  every 
species  of  arum,  contains 
an  acrid  principle,  when 
fresh,  which  can  be 
driven  off  by  heat,  and 
is  not  imparted  to  water 
or  alcohol,  the  ordinary 
pharmaceutical  men- 
strua. By  drying,  the 
principle  is  lost,  and  the 
root  becomes  inert,  con- 
taining a large  quantity 
of  starch,  which  can  be 
separated  from  it  and 
taken  as  an  aliment.  It  is  sometimes  used,  when  fresh,  as  a diapho- 


Afum  triphyllum. 


324 


SPECIAL  DIAPHORETICS. 


retie  and  expectorant.  The  recently  dried  root  is  usually  given, 
but  it  has  not  much  efficacy.  The  dose  is  ten  grains. 

18.  Car'thamus,  Dyers’  Saffron.  The  flowers  of  Car'thamus 
tincto'riuSj  Dyerh  Saffron Bastard  Saffron  or 
Safflower  ; Sex.  Syst.  Syngenesia  ^Equalis;  Nat. 
Ord.  Compositee  Cinarocephalse — a plant,  which 
is  indigenous  in  Egypt  and  the  Levant,  but  is 
cultivated  in  Europe  and  in  this  country,  where 
it  bears  the  name  of  American  Saffron — are 
sometimes  administered  in  warm  infusion,  ( Car- 
tham.  Jss,  Aquee^  Oj,)  as  a diaphoretic,  in  domes- 
tic practice,  to  favour  the  eruption  of  the  major 
exanthemata.  They  are  rarely  prescribed  by  the 
physician  ; and  the  same  may  be  said  of 

19.  Crocus,  Saffron ; the  stigmas  of  Crocus 
sati'vus^  Autum'nal  Crocus ; Sex.  Syst.  Trian- 
dria  Monogynia  ; Nat.  Ord.  Iridaceae  ; — a native  of  Asia  Minor, 
and  Eastern  Europe  ; but  cultivated  in  various  parts  of  the  world. 
Saffron  is  in  the  primary  list  of  the  Pharmacopoeia  of  the  United 
States,  but  only  because  it  enters  as  a colouring  agent  into  various 
preparations ; in  some  of  which  it  is  retained  as  a relic  of  antiquity, 
not  because  of  any  valuable  remedial  virtues.  In  domestic  practice, 
it  is  still  given  in  the  same  cases  as  carthamus,  in  the  form  of 
Saffron  Tea.  Its  nominal  dose  is  gr.  x to  3ss  ; but  it  is  almost 
inert. 

It  enters  into  the  Pilulce  Aloes  et  Myrrhce^  the  Tinctura  Aloes  et 
Myrrhce ; the  Tinctura  Cinclionce  Composita,  and  the  Tinctura  Rhei 
et  Sennee^  of  the  Pharmacopoeia  of  the  United  States. 

20.  Sambu'cus,  Elder  Flowers.  The  flow^ers  of  Sambu'eus  Cana- 
densis, or  Common  Elder  ; Sex.  Syst.  Pentrandria  Trigynia ; Nat. 
Ord.  Caprifoliaceee  ; a shrub,  which  is  very  common  in  the  United 
States,  flowering  from  May  to  July,  are  sometimes  used  as  a dia- 
phoretic in  the  form  of  infusion.  They  contain  a small  quantity  of 
volatile  oil,  which  may  be  obtained  by  distillation  with  water,  — con- 
stituting the  Aqua  Samhu'ei,  or  Elder  Flower  Water  of  the  British 
Pharmacopoeias,  which  is  used  to  flavour  mixtures  and  emulsions. 

III.  Topical  Diaphoretics. 

21.  CALOR'IC. 

Along  with  the  internal  agents  already  described,  caloric,  in  vari- 
ous forms  of  baths,  is  often  employed  as  a topical  diaphoretic.  Of 
the  effects  of  baths  on  the  animal  economy  in  health,  mention  has 
been  made  elsewhere.  (See  the  author’s  Human  Health,  p.  358  ; 
Philad.  1844.)  It  remains  to  speak  of  them  here  as  therapeutical 
agents  of  the  diaphoretic  class. 


Fig.  47. 


WARM  VAPOUR  BATH. 


325 


a,  WARM  AIR  BATH. 

Air,  when  heated  to  from  85°  to  100°  of  Fahrenheit’s  scale,  and 
placed  in  contact  with  the  cutaneous  surface,  is  a gentle  excitant  to 
the  secretory  apparatus  of  the  skin,  anti  occasions  copious  perspira- 
tion. When  heated  to  a greater  degree,  it  forms  the  hot  air  bath, 
which,  in  place  of  inducing  diaphoresis,  causes  a degree  of  excite- 
ment that  arrests  the  secretion.  Warm  air  has  been  applied  in  va- 
rious ways  ; either  by  raising  the  bed-clothes  from  the  body  by 
means  of  a wicker  cradle,  and  then  allowing  the  tube  from  a lamp 
to  pass  under  the  bed-clothes,  or  by  burning  alcohol  in  a cup  or 
saucer  under  the  same;  in  either  case,  the  patient’s  head  and  neck 
being  outside  the  bed-clothes.  It  might  be  applied  also  by  means 
of  one  of  the  ordinary  fumigating  apparatuses,  in  which  vapours 
are  made  to  come  in  contact  with  the  body  ; or  by  heating  the  air 
of  an  apartment,  by  means  of  a cockle  or  some  appropriate  stove. 
Dry  heated  air  is  not,  how^ever,  inhaled  with  entire  impunity  in  all 
cases.  It  is  greedy  of  moisture,  and,  where  the  lungs  are  diseased, 
maj  occasion  much  distress  in  respiration.  At  the  temperature  of 
85°  to  90°,  applied  to  the  surface  in  either  of  the  two  first  modes,  it 
is  said  by  Dr.  A.  T.  Thomson  to  be  not  stimulating,  — to  have  a 
soothing  effect  on  the  nervous  system,  — and  to  be  more  certainly 
productive  of  sweating  than  either  the  warm  water  bath  or  the  va- 
pour bath.” 

A bath  of  this  kind  has  been  found  useful  in  chronic  rheumatism, 
and  in  various  neuralgic  affections  of  deep-seated  parts  ; stiffness  of 
the  joints,  &c.  It  is  said,  also,  to  have  exerted  a beneficial  agency 
in  cutaneous  affections,  especially  of  the  squamous 'kind.  Where  the 
blood  has  receded  from  the  surface,  as  in  cases  of  congestive  fever, 
or  in  spasmodic  cholera,  the  bath  is  rendered  more  excitant  by  ele- 
vating the  temperature.  It  then  becomes  a true  excitant,  and,  ac- 
cordingly, is  treated  of  under  another  head.  (See  Excitants.) 

h.  WARM  VAPOUR  BATH. 

The  warm  vapour  bath  holds  a medium  place  between  the  last  and 
the  warm  water^bath.  The  vapoury  medium  is  a better  conductor  of 
heat  than  air,  and  worse  than  water  ; hence  its  temperature,  to  pro- 
duce analogous  effects,  must  be  higher  than  that  of  the  warm  water 
bath.  The  vapour  bath  differs,  too,  according  to  the  mode  in  which 
it  is  applied.  In  the  case  of  the  Russian  vapour  hath^  the  whole 
body  is  exposed  to  the  vapour,  and  it  is  of  course  inhaled  into  the 
lungs.  In  other  cases,  the  vapour  is  made  to  come  in  contact  wdth 
the  whole  of  the  body,  except  the  head  — none  passing  into  the 
lungs.  In  another  work,  already  referred  to,  [Human  Healthy  p.  47.) 
the  author  has  described  the  arrangement  and  effects  of  the  Russian 
bath,  which  is  used  mainly  as  a hygienic  agent. 

Owing  to  these  differences  between  the  vapour  bath  and  the  warm 
water  bath,  it  has  been  laid  down,  that  the  temperature  of  the  for- 
voL.  I. — 28 


326 


SPECIAL  DIAPHORETICS. 


mer  should  always  exceed  that  of  the  latter.  If,  however,  the  whole 
body  be  immersed  in  vapour,  so  that  it  is  inhaled,  it  is  recommended, 
that  the  temperature  should  be  a little  less  than  if  the  body  alone  were 
exposed  to  it;  as  the  inhalation  of  vapour  arrests  the  cooling  process 
of  evaporation  from  the  lungs. 

The  following  is  given  on  excellent  authority,  — that  of  Dr.  F orbes, 
— as  a comparative  view  of  the  heating  powers  of  water,  and  of 
vapour,  according  as  the  latter  is  breathed  or  not. 


WAT  Ell 

VAPOUH. 

INot  breathed. 

Breathed. 

Tepid  Bath, 

85°—  92° 

9b^ — 106'^ 

900—100° 

Warm  Bath, 

92°—  98° 

106°— 120° 

100°— 110° 

Hot  Bath, 

98°_106° 

1200—160° 

1J0°— 130° 

In  the  work  already  cited,  and  in  another  part  of  the  present,  the 
author  has  stated  the  effects  of  the  hot  vapour  bath  to  be  — like 
those  of  the  hot  water  bath  — powerfully  excitant,  and  therefore, 
not  properly  falling  under  consideration  here.  Those  of  the  warm 
vapour  bath  are  moderately  excitant,  but  powerfully  diaphoretic, 
producing  a general  equalising  influence,  followed  by  a feeling  of 
languor,  and  by  somnolency.  Hence,  it  may  be  used  with  marked 
advantage  in  slight  inflammatory  affections,  especially  in  those  of 
the  gastro-pulmonary  mucous  membrane.  In  such  cases,  it  would 
obviously  be  better,  that  the  bath  should  be  so  administered,  that  air 
loaded  with  vapour  should  be  received  into  the  air-passages.  It 
may  also  be  of  service  in  dry  chronic  cutaneous  eruptions,  and  in 
rheumatic  affections  ; although  in  these  last,  the  hot  vapour  bath 
proves  more  serviceable. 

For  therapeutical  purposes,  the  patient  maybe  covered  with  an  oil 
silk  garment,  which  ties  round  the  neck,  and  is  made  to  fall  at  a dis- 
tance around  him.  A tube,  connected  with  a kettle  of  boiling  water, 
placed  over  a spirit  lamp,  may  then  be  passed  under  the  oil  cloth  at 
such  a distance  from  the  patient’s  body  as  to  prevent  his  being 
scalded  ; and  in  this  way  warm  vapour  may  be  made  to  come  in 
contact  with  it.  In  certain  of  the  public  and  private  bathing  estab- 
lishments an  appropriate  apparatus  is  provided  for  taking  a steam 
bath  at  any  temperature. 

Sometimes  the  vapour  is  medicated  by  impregnating  it  with  aro- 
matic oils  from  plants  boiled  in  the  water,  or  from  some  volatile  oil 
being  added  to  it  in  the  vessel  ; but  although  these  may  somewhat 
augment  the  excitant  action  of  the  vapour,  there  is  no  great  reason 
to  believe  that  much  remedial  agency  has  been  exerted  by  them. 
Of  other  vaporous  agents  that  may  be  added,  mention  is  made  under 
those  agents. 

C.  WARM  WATER  BATH. 

The  tepid  hath^  — the  temperature  of  which  may  be  ranged  be- 


WARM  BATH. 


327 


tween  75°  and  90°  of  Fahrenheit,  may  rather  be  regarded  as  a re- 
frigerant than  as  a diaphoretic,  and,  therefore,  its  therapeutical  effects 
fall  more  properly  under  Refrigerants,  and  are  considered  else- 
where. The  ordinary  temperature  of  the  warm  bath  is  between 
90°  or  92°  and  96°  or  98°.  Even  when  as  low  as  90°,  and  lower, 
a pleasurable  feeling  of  warmth  is  experienced  on  immersion,  be- 
cause the  temperature  of  the  air  is  generally  below  this  point,  and, 
accordingly,  the  body  is  commonly  parting  with  more  caloric. 

Although  when  first  applied,  the  effect  may  be  to  gently  excite 
the  secretory  organs  of  the  skin,  the  great  influence  is  the  equalisa- 
tion exerted  by  it,  owing  to  the  blood  being  solicited  every  where 
to  the  surface.  Under  this  agency,  inflammatory  concentrations  are 
broken  in  upon,  and  hence  it  becomes  one  of  the  most  beneficial 
remedies  in  minor  degrees  of  internal  hyperaemia  especially,  and, 
likewise,  in  cases  where  the  inflammatory  mischief  is  to  a greater 
amount.  Its  main  action  is,  indeed,  sedative,  — that  is,  the  gentle 
excitation  first  produced  by  it  on  the  cutaneous  system  is  so  speedily 
followed  by  sedation,  that  the  latter  effect  is  markedly  predominant. 
Accordingly,  although,  on  immersion,  the  pulse  may  become  more 
frequent,  and  the  respiration  somewhat  accelerated,  languor  and 
evidences  of  diminished  action  soon  succeed  ; with  impairment  of 
muscular  power;  a tendency  to  faintness,  and  somnolency.  Hence, 
it  is  used  by  the  surgeon  to  relax  constricted  parts,  as  in  cases  of 
luxations,  hernia,  and  of  the  passage  of  urinary  or  biliary  concre- 
tions. 

In  almost  all  acute  phlegmasise,  after  more  powerful  sedatives 
have  been  employed,  the  warm  bath  is  found  of  decided  service, 
on  the  principle  just  mentioned  ; hence,  in  thoracic  and  abdominal 
inflammations,  more  especially  when  occurring  in  children,  it  is 
much  used,  and  there  is  no  remedy  more  soothing.  In  eruptive 
fevers,  especially  where  the  eruption  does  not  appear  kindly,  its 
beneficial  agency  is  often  marked,  and  it  is  especially  applicable  to 
cases  where  the  temperature  of  the  surface  is  depressed,  and  the 
circulatory  action  feeble.  In  such  cases,  it  ought  to  approach  the 
hot  bath  in  temperature,  and  many  cases  absolutely  require  the 
strong  excitant  influence  of  water  heated  above  the  temperature  of 
the  body.  In  chronic  inflammations,  the  properly  directed  use  of 
the  warm  bath  is  not  less  serviceable.  In  dyspepsia,  too,  it  exerts 
a salutary  effect,  especially  when  conjoined  with  friction  on  the  sur- 
face ; and  in  various  spasmodic  diseases, — as  convulsions,  particu- 
larly of  children,  — its  soothing  and  equalising  influence  is  ad- 
mitted by  all.  There  is,  however,  so  much  inconvenience  in  its 
employment  in  the  last  case,  when  an  infant  is  suddenly  taken 
with  convulsions,  that,  by  some,  as  by  Dr.  Dewees,  friction Hias 
been  substituted. 

Like  the  warm  vapour  bath,  it  may  be  beneficial  in  various  dry 
cutaneous  diseases,  and  in  rheumatic  affections ; and  there  are  cases 


328 


SPECIAL  DIAPHORETICS. 


of  amenorrhoea  and  of  dysmenorrhoea,  — in  the  latter  especially, 
when  accompanied  by  a membranous  secretion,  the  result  of  an' 
excited  action  of  the  secretory  vessels  of  the  lining  membrane  of 
the  uterus,  — in  which  it  is  of  decided  service. 

Dr.  A.  T.  Thomson  has  invented  an  apparatus,  which  he  regards 
as  the  simplest  warm  bath.  It  consists  of  a hammock  a,  of  India 
rubber  cloth,  which  is  extended  upon  two  long  poles  b 6,  passed 

through  a 

Fig- 48.  broad  seam  on 

each  side  of 
the  hammock, 
and  kept 
asunder  by 
the  cross  • 
pieces,  c, 
which  are  at- 
tached to  the 
Warm-Bath.  poles  by  the 

thumb  screws 

d d d.  At  one  end  of  the  hammock  is  an  air  pillow,  which  can  be 
readily  blown  up  ; and  below  it  is  a flexible  tube  /,  made  of  the 
same  material  as  the  hammock,  by  which  any  water  it  may  contain 
can  be  readily  drawn  off.  When  the  poles  are  fixed,  as  in  the  mar- 
ginal figure,  and  the  open  end  of  the  flexible  tube  twisted  round 
one  of  the  thumb  screws,  the  bath  is  ready  to  receive  the  water. 

It  may  be  supported  upon  two  chairs,  or  upon  folding  tressels  e e.  The 
advantage  of  this  bath,  according  to  Dr.  Thomson,  is,  that  it  re- 
quires a very  small  quantity  of  ^water  compared  with  that  demanded 
for  other  baths,  and  that  when  the  bathing  is  completed,  the  poles 
and  the  folding  tressels  can  be  placed  aside  in  a small  closet,  or 
in  the  corner  of  a dressing  room,  and  the  hammock,  when  dried,  be 
put  into  a drawer. 

Partial  warm  baths  are  much  employed,  where  the  desire  is 
to  affect  particular  portions  of  the  cutaneous  sur- 
face, and  through  them,  the  wTole  system,  or 
organs  in  the  vicinity  of  those  to  which  they 
are  applied.  Thus,  the  warm  Hipbath  is  em- 
ployed particularly  in  inflammatory  and  other 
affections  of  the  abdominal  and  pelvic  viscera  : 
the  warm  foot-bath,  in  colds,  and  with  the  view 
of  restoring  the  menstrual  secretion  when  ar- 
rested. The  influence  of  the  warmth  is  soon 
extended  to  other  parts  of  the  capillary  system, 
and  diaphoresis  frequently  results  — especially 
if  it  be  favoured  by  the  warmth  of  bed,  and  the 
use  of  warm  diluent  drinks.  When  the  object 
is  to  exert  a revellent  influence  in  these  cases,  the  temperature  of 


Fig.  49. 


FRICTION.  329 

the  water  is  elevated,  and  salt  and  mustard  are  at  times  mixed  with 
it.  The  ARM-BATH  and  hand-bath  are  rarely 
used  except  as  mere  topical  agents. 

In  the  use  of  the  warm  bath,  there  is  rarely 
any  shock  experienced  ; — in  other  words, 
no  powerful  impression  is  made  by  it  on  the 
nervous  system  : hence  no  apprehension  need 
be  entertained  of  its  producing  injurious  con- 
sequences except  in  highly  impressible  per- 
sons. In  such,  or  where  there  is  a tendency 
to  encephalic  affections,  the  temperature  must 
be  carefully  regulated  so  that  it  be  not  too  ex- 
citant. Both  the  general  and  topical  bath  are  likewise  considered 
to  be  unadvisable  in  pregnancy,  and  whilst  the  catamenia  are  flow- 
ing ; but  the  effects,  in  such  cases,  have  doubtless  been  exag- 
gerated. 

The  time,  during  which  the  individual  should  remain  in  the  bath, 
must  be  determined  by  the  nature  of  the  case.  In  acute  diseases, 
a few  minutes  may  be  sufficient,  but  where  it  is  desirable  to  relax 
either  the  skin,  as  in  cutaneous  diseases,  or  the  powers  of  the  sys- 
tem, the  patient  may  continue  in  it  for  a considerable  time.  Where 
the  affection  is  chronic,  the  bath  may  be  taken  two  or  three  hours 
after  a meal,  so  that  digestion  may  not  be  interfered  with.  When 
the  patient  leaves  the  bath,  friction  with  warm  flannels  may  be  used 
in  chronic  cases.  In  acute  cases,  he  may  be  removed  from  it,  and 
be  placed  in  blankets. 

Warm  fomentations  and  Poultices  act  as  topical  baths,  by 
virtue  of  their  warmth  and  moisture.  They  relax  the  parts  with 
which  they  come  in  contact,  and,  as  in  the  case  of  pediluvia,  the  sooth- 
ing influence  they  exert  on  the  parts  with  which  they  touch  is 
extended  elsewhere,  so  that  a sedative  influence  may  be  exerted  on 
the  system  generally,  and  especially  on  the  vessels  that  may  be 
affected  with  any  internal  hypersemia. 

Injections  of  warm  water  thrown  into  the  rectum  or  vagina, 
in  cases  of  diseases  of  the  uterus,  peritoneum,  or  the  upper  portions 
of  the  intestines,  act  in  the  same  manner  as  warm  fomentations. 

d.  FRICTION. 

Friction  of  the  body,  with  dry  flannels  or  with  the  flesh-brush, 
excites  the  action  of  the  secretory  organs  of  the  cutaneous  surface, 
and  in  moderation  tends  to  the  production  of  diaphoresis.  It  is 
rarely,  however,  employed  with  this  view,  except  as  an  adjunct  to 
the  warm  bath  ; and  even  then  is  more  used  hygienically  than  thera- 
peutically. Friction  is  frequently  employed  topically  to  modify  nutri- 
tion, but  its  consideration  in  that  light  will  fall  under  the  head  of 
Eutrophics. 

28^ 


Fig.  50. 


330 


NARCOTICS. 


SECTION  IV. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  NERVOUS  SYSTEM. 


I.  NARCOT'ICS. 

Synox.  Obstupefacientia^  Slupefacientia. 

Definition  of  Narcotics  — May  be  used  as  excitants,  and  as  sedatives  — Their  action 
elucidated  by  that  of  Opium  — May  act  locally  as  well  as  generally — Mental  nar- 
cotics — Therapeutical  application  of  narcotics  — In  febrile  diseases  — In  the  phleg- 
niasiffi,  &c.  — Special  narcotics. 

Narcotics  greatly  resemble,  in  their  action — when  administered 
in  appropriate  doses — the  class  of  sedatives.  They  differ  from  them, 
however,  in  several  respects.  Whilst  the  action  of  sedatives  is  not 
preceded  by  any  degree  of  excitation,  that  of  narcotics  always  is. 
In  minute  doses,  again,  narcotics  may  produce  none  of  the  effects 
that  characterise  them  when  given  in  large  doses.  Their  agency 
maybe  altogether  excitant;  and,  with  the  view  of  obtaining  the 
modification  in  the  organic  actions,  which  such  agency  is  capable  of 
exerting,  they  are  occasionally  exhibited  in  small  quantity. 

When  given  to  the  extent  of  inducing  their  peculiar  action,  they 
may  be  defined  — ‘‘  agents,  which  first  excite  and  then  diminish 
nervous  action,  and,  in  appropriate  doses,  stupefy.”  The  power  of 
stupefying  must,  indeed,  be  esteemed  one  of  their  main  character- 
istics. 

Although  the  above  definition  may  apply  generally  to  their  opera- 
tion, when  they  are  administered  in  a dose  proper  to  produce  a nar- 
cotic influence,  it  is  obvious,  from  what  has  been  said,  that  it  is  not 
wholly  applicable,  when  they  are  given  as  mere  excitants : in  such 
case,  they  may  not  diminish  nervous  action,  and  stupefy.”  They 
can  then,  however,  be  regarded  as  excitants  only  ; but,  in  adequate 
doses,  the  latter  part  of  the  definition  is  strikingly  appropriate  ; and 
the  effects  mentioned  must  be  regarded  as  the  most  essential  conse- 
quents on  their  employment.  Even  when  they  are  administered  in 
a full  dose,  some  degree  of  excitation  is  first  perceptible;  the  func- 
tions of  circulation,  innervation,  and  secretion  become  more  or  less 
modified  ; the  pulse  beats  more  rapidly,  and  forcibly  ; the  skin  is 
hotter  and  drier  than  natural ; the  nervous  system  exhibits  greater 
impressibility  ; and  the  mouth  and  fauces  are  dry,  or  their  ordinary 
secretions  are  more  tenacious  than  natural  ; but  these  evidences  of 
excitement  soon  pass  off’ — more  rapidly  in  proportion  to  the  size  of 
the  dose,  — and  a train  of  phenomena  indicating  sedation  follows 
those  of  excitement ; the  respiration  becomes  slower ; the  skin  moist ; 
the  pulse  reduced  to  the  natural  standard,  or  even  below  it ; the  im- 
pressibility of  the  nervous  system  is  obtunded  ; the  tongue  becomes 
moist  ; and  all  the  symptoms  exhibit  that  a sedative  and  soothing 


NARCOTICS. 


331 


agency  has  been  exerted.  Perhaps,  in  every  case,  however  large 
the  dose  of  the  narcotic  may  be,  some  degree  of  excitement  might 
be  perceived  as  a precursor  of  the  sedation,  were  due  attention 
paid  ; but  the  sedative  effect  of  a very  large  quantity  of  any  of  the 
narcotics  supervenes  so  rapidly  on  the  stimulant,  that  the  attention 
of  the  practitioner  is  scarcely  directed  to  the  latter  operation  — espe- 
cially as  it  is  not  the  one  for  the  production  of  which  he  has  pre- 
scribed it. 

The  marked  difference  between  a stimulant  and  a sedative  dose 
of  the  same  agent  can  be  understood  from  the  cases,  so  often  re- 
lated in  the  newspapers,  of  persons,  who,  for  wagers,  have  swallow- 
ed, at  once,  a large  draught  of  some  alcoholic  liquor.  The  sedative 
effects  of  this  powerful  excitant — excitant,  that  is,  in  a smaller 
dose  — are  so  speedily  exerted,  that  a stop  may  be  put  to  all  the 
functions,  without  there  being  any  marked  symptoms  of  previous 
hurry  in  the  organic  actions. 

When  a narcotic  is  taken,  the  first  effects  occur  in  the  nerves  dis- 
tributed to  the  lining  membrane  of  the  stomach.  These  are  ren- 
dered less  impressible,  and  the  obtunding  influence  is  soon  extended 
to  the  great  nervous  centres,  which  are  affected  like  the  nerves  with 
which  the  narcotic  first  comes  in  contact.  In  this  manner,  the  func- 
tion of  innervation  generally  has  its  activity  diminished  ; and,  there- 
fore— directly  as  well  as  indirectly — the  gastric  functions  may  be 
impaired.  If  the  narcotic  be  taken  before  eating,  and  when  a marked 
desire  for  food  is  present,  the  appetite  may  be  diminished  or  extin- 
guished, under  the  new  condition  of  innervation.  If  food  have  been 
received  into  the  stomach,  chymification  may,  for  like  reasons,  be 
retarded  ; and  the  whole  of  the  digestive  operations  — chymification, 
chylification  and  defecation  — may  exhibit  an  obvious  degree  of 
torpor.  It  can  thus  be  comprehended,  that  the  use  of  a narcotic 
may  be  followed  by  constipation,  and  that  it  may  be  well  adapted 
for  diarrhoea,  where  an  indirect  astringent  agency  appears  to  be  indi- 
cated. The  precise  modus  operandi  of  the  narcotic  may,  in  these 
cases,  vary  with  the  dose  : where  it  is  large,  the  whole  function  of 
innervation  may  be  blunted  ; and  not  only  the  secretions,  but  the 
peristole  of  the  intestines  be  diminished  ; whilst  if  the  dose  be 
smaller,  the  effect  maybe  mainly  exerted  upon  the  nerves  distributed 
to  the  gastric  apparatus,  without  the  rest  of  the  nervous  system  ma- 
terially participating.  In  cases  of  diarrhoea,  opium,  like  every  the- 
rapeutical agent,  has  a relative  action  ; and  the  same  may  be  said  of 
its  employment  in  other  morbid  conditions.  If  irritation  or  inflam- 
mation exist  in  any  portion  of  the  alimentary  canal,  such  irritation  or 
inflammation  may  be  allayed  by  a sedative  dose  of  a narcotic  ; and, 
in  this  way,  the  pathological  condition  being  removed,  its  symptom 
— the  increased  number  and  morbid  character  of  the  evacuations — 
may  cease  likewise. 

It  has  been  a very  common  remark,  that  opium  is  not  well  adapted 
for  cases  of  pneumonia,  bronchitis,  &c.,  because  it  “ diminishes  the 


332 


NARCOTICS. 


secretions,”  but  this  appears  to  be  a faulty  method  of  explaining  its 
action.  The  suppression  of  secretions  is  not  a pathological  con- 
dition. It  is  only  the  symptom  of  such  a condition,  and  when  we 
state,  that  the  indication  is  to  restore  the  secretions^  if  the  expression 
have  any  meaning  at  all,  it  can  only  convey  the  idea,  that  the  pa- 
thological condition,  which  occasions  their  suppression,  must  be  re- 
moved. Now,  we  know,  that  the  first  consequence  of  the  inflam- 
mation of  a mucous  membrane  is  a diminution  of  its  wonted  secre- 
tion ; and  that,  after  the  inflammation  has  persisted  for  a time,  an 
increase  of  the  secretion  takes  place  ; but  it  is  no  longer  of  a healthy 
character.  It  is  a secretion,  accomplished  by  vessels  labouring 
under  inflammatory  excitement.  Two  opposite  effects,  then,  on  the 
secretory  function,  are  produced  by  different  stages  of  inflammation. 
Yet,  the  indication,  in  both  cases,  must  obviously  be  alike.  It  must 
be,  to  remove  the  pathological  condition,  of  which  these  effects  are 
symptomatic.  A narcotic  we  know  to  be,  in  appropriate  doses,  a 
sedative  ; — that  is,  it  is  capable  of  diminishing  the  force  of  the  cir- 
culation, and  the  energy  of  innervation.  It  is,  therefore,  well  adapted 
for  acting  as  a contra-stimulant  — for  allaying  inflammatory  excite- 
ment. A knowledge  of  its  properties  would  suggest  to  us  the  pro- 
priety of  its  employment  in  the  diseased  state  of  mucous  membrane, 
instanced  above  ; and  experience  ought  to  show,  — as  it  does  daily 
show,  — that  in  one  of  the  conditions  assumed,  — that  is,  in  the  early 
period  of  mucous  inflammation,  — it  will  restore  the  secretions  ; and, 
in  the  other,  where  the  mucous  secretions  have  become  profuse,  and 
morbid,  it  will  diminish  them,  — by  diminishing  the  inflammation 
that  occasioned  them.  It  is  obviously,  therefore,  incorrect  to  lay 
down  the  broad  law,  that  opium  diminishes  the  secretions^  and  that 
its  use  is  improper  whenever  the  indication  is  to  restore  the  secretions. 
Such  an  indication  ought  never  to  be  imagined.  It  is  unmeaning, 
and  can  only  have  been  suggested  in  the  ignorance  of  true  pathology; 
and  the  author  is  happy  to  find,  that  a recent  writer  on  therapeutics 
— Dr.  Spillan" — expresses  his  entire  accordance  with  these  senti- 
ments, as  contained  in  the  first  edition  of  this  work.  In  cases  of 
pneumonia,  where  the  expectoration  has  been  free,  a diminution  of 
the  sputa  has  seemed  to  supervene  on  the  administration  of  nar- 
cotics ; but  this  has  been  owing  to  the  agent  not  having  been  ad- 
ministered in  a dose  adapted  to  the  pathological  condition  of  the 
pulmonary  organs.  Where  the  opium  is  given  in  a small  dose  — 
as  is  too  often  the  case  — it  will  as  surely  add  to  the  inflammation, 
as  the  same  amount  of  any  other  excitant ; and  if  we  add  to  the 
inflammation,  we  may  arrest  the  secretion  altogether,  by  bringing 
back  that  condition  of  the  tissue,  which  existed  at  the  onset  of  the 
inflammation  ; but  if,  in  this  very  case,  a full  sedative  dose  were 
administered,  none  of  the  evils  might  be  found  to  follow.  The 
sedative  would  allay  the  excited  organic  actions,  and  if  the  secre- 
tion were  diminished  — as  it  probably  would  be — it  would  be  a 
fortunate  diminution,  because  arising  from  lessened  inflammatory 


MODUS  OPERANDI.  333 

excitement  in  the  lining  membrane  of  the  bronchial  tubes,  or  in  the 
tissues  in  their  vicinity. 

Another  example  may  be  taken,  where  the  secretions  and  excre- 
tions are  manifestly  facilitated  by  narcotics.  It  has  been  already 
remarked,  that  opium  is  administered  in  cases  where  there  is  an 
undue  number  of  alvine  evacuations,  with  the  view  of  exerting  a 
constipating  effect.  But  it  is  no  less  administered  where  constipa- 
tion is  dependent  upon  certain  pathological  conditions.  When  en- 
teritis or  inflammation  of  the  peritoneal  coat  of  the  intestines  ex- 
ists, constipation  is  a common  symptom  ; and,  on  the  other  hand, 
if  the  inflammation  be  seated  in  the  mucous  coat,  diarrhoea  is  as 
common.  Why  this  difference  should  exist  is  owing  to  the  inflam- 
matory condition  of  the  follicles,  and  of  the  mucous  membrane 
generally,  being  accompanied,  after  the  disease  has  continued  for 
a short  time,  by  augmented  secretion.  It  might  seem,  however, 
that  as  the  peritoneal  coat  so  closely  invests  the  muscular,  the  latter 
ought  to  be  thrown  into  inordinate  contraction,  and  an  increase 
be  occasioned  in  the  number  of  the  evacuations  from  this  cause. 
Such  contraction  does  exist,  but  the  necessary  irritation  in  the 
lining  membrane  is  wanting  to  induce  diarrhoea  ; the  contraction  of 
the  fibres  has  more  of  the  character  of  spasm  ; and  a derivative 
effect  is  perhaps  exerted,  owing  to  the  concentration  of  the  excited 
organic  actions  in  the  peritoneal  coat  diminishing  the  amount  of 
secretion  from  the  mucous  coat  ; in  this  manner,  constipation  comes 
to  be  one  of  the  phenomena  of  peritoneal  enteritis.  In  such  a 
case,  opium,  judiciously  administered,  exerts  its  sedative  agency  ; 
diminishes  the  inflammatory  action  in  the  peritoneal  coat,  and  re- 
solves the  spasm  in  the  muscular  coat ; so  that  the  causes  of  the 
constipation  being  obviated,  it  ceases  ; and  we  thus  have  a laxative, 
or  cathartic  effect,  induced  by  remedies,  which  in  other  pathologi- 
cal conditions,  are  well  adapted  for  producing  opposite  results. 
These  are  cases,  which  exhibit  the  value  of  the  possession  of  sound 
pathological  and  therapeutical  knowledge.  We  discover  empiri- 
cally the  property  of  our  drug,  and  having  accurately  appreciated 
the  agency  it  is  capable  of  exerting,  we  can  say  h priori  what  will 
be  the  pathological  condition,  in  which  the  greatest  benefit  may  be 
reaped  from  its  employment.  Accordingly,  as  the  author  has  re- 
marked in  an  early  part  of  this  volume,  analogy  has  led  to  the  em- 
ployment of  the  invaluable  agent  — opium  — in  cases,  in  which 
some  years  ago  it  would  never  have  been  ventured  upon.  Some 
pathologists  have  considered  it  best  adapted  for  phlegmasiae  of  the 
peritoneum  — both  of  the  membrane  proper,  and  its  extensions  over 
the  different  viscera.  Such  was  the  view  of  the  indefatigable  in- 
vestigator of  the  diseased  conditions  of  the  animal  economy  — 
Armstrong.  In  these  phlegmasise,  he  conceived  it  to  be  perhaps 
the  most  efficient  therapeutical  agent  that  we  possess:  and,  although 
he  esteemed  it  best  to  unite  it  with  bloodletting,  and  to  repeat 
both  remedies  according  to  the  urgency  of  the  case,  he  was  dis- 


334 


NARCOTICS. 


posed  to  think,  that  if  he  himself  were  labouring  under  perito- 
neal enteritis,  and  were  told,  that  he  must  rest  his  hopes  upon  the 
lancet  singly,  or  upon  opium  singly,  he  should  be  disposed  to  select 
the  latter. 

What  Armstrong  said  of  the  use  of  opium  in  these  cases  has  been 
extended  to  similar  pathological  conditions  in  other  serous  tissues 
and  elsewhere,  and  many  advantages  have  accrued  from  its  employ- 
ment, in  some  form  of  preparation,  in  cases  in  which,  at  one  time, 
its  use  was  unknown,  or  considered  inappropriate. 

In  a work  on  Therapeutics  by  Dr.  Chapman,  of  Philadelphia,  we 
have  the  following  remark.  — Concerning  the  operation  of  opium, 
medical  sentiment  continues  to  be  divided,  though  the  preponde- 
rance is  decidedly  in  favour  of  its  stimulant  properties,  and  with 
such  an  impression  it  is  employed.”  It  is  this  belief,  as  well  as  the 
want  of  knowledge  of  the  essential  difference  in  the  action  of  nar- 
cotics according  to  the  dose,  that  has  occasioned  opium  to  be  dis- 
carded in  cases  of  undue  vascular  and  nervous  excitement  for  the 
removal  of  which  it  is  so  admirably  adapted.  Impressed  with  an 
unfavourable  sentiment  towards  its  use  — a sentiment  derived  from 
authors,  and  teachers  — the  young  practitioner  is  apt  to  administer  it 
in  phlegmasial  affections,  either  in  doses  so  small,  that  no  sedative 
effect  is  induced,  or,  in  his  caution,  he  strikes  the  medium  ground 
between  stimulation  and  sedation : in  the  former  case,  he  witnesses, 
perhaps,  an  aggravation  of  the  excitement,  and,  in  the  latter,  either 
no  effect  whatever,  or  one  of  aggravation ; and  he,  therefore,  too 
hastily  concludes,  that  the  use  of  opium  is,  in  such  cases,  inappro- 
priate and  injudicious.  Under  these  feelings,  he  never  employs  it 
afterwards,  and  yet  he  conceives  himself  entitled  to  say,  from  expe- 
rience, that  opium  is,  in  no  case,  advisable,  where  inflammation  is 
present. 

Such  were  the  views  strenuously  inculcated  when  the  author  com- 
menced the  study  of  medicine  ; and  many  a practitioner  of  the  pre- 
sent day,  who  may  entertain  them,  will  find,  that  his  impressions 
have  been  derived  from  others.  A little  experience  sufficed,  in  the 
author’s  case,  to  induce  him  to  throw  oii  the  trammels  of  authority, 
and  the  judicious  remarks  of  Armstrong  confirmed  him  in  his  course. 
Both  in  public  and  in  private  practice,  he  has  administered  it  largely ; 
and,  from  the  results,  is  prepared  to  say,  that  we  have  not  inphleg- 
masise  in  general  a more  valuable  agent,  if  we  except  the  lancet ; 
and  there  are  obscure  cases  of  inflammatory  action  — in  puerperal 
females  especially  — where  it  can  be  advantageously  employed  when 
the  lancet  cannot.  It  has,  indeed,  been  argued,  that  where  such 
affections  have  been  relieved  by  opium,  the  very  fact  shows,  that 
they  were  not  inflammatory,  and  farther,  that  we  may  often  mistake 
neuralgic  diseases  for  inflammatory,  as  is  sufficiently  shown  by  the 
circumstance,  that  narcotics  completely  remove  affections,  which 
were  previously  supposed  to  be  inflammatory.  The  result  in  no  re- 
spect invalidates  the  diagnosis.  Opium  is  a precious  sedative,  and 


MODUS  OPERANDI.  335 

it  is,  therefore,  as  well  adapted  for  the  one  class  of  cases  as  for  the 
other. 

A very  slight  reflection,  on  the  mode  in  which  opium  relieves 
pain,  will  place  this  subject  in  a striking  light.  It  will  show  how 
a narcotic  may  prevent  the  aggravation  of  diseased  action.  If  we 
apply  opium  to  a part  of  the  dermoid  surface,  whose  organic  ac- 
tions are  morbidly  modified,  the  effect  of  the  narcotic  is  exerted  on 
the  nervous  ramifications  themselves  ; their  impressibility  is  dimin- 
ished ; and  the  irritation,  under  which  they  have  been  labouring, 
may  be  no  longer  appreciated  by  the  brain.  In  the  same  manner, 
if  the  narcotic  be  swallowed,  its  effects  are  exerted  upon  the  nerves 
of  the  stomach,  and,  through  them,  on  every  part  of  the  nervous 
system.  The  brain  no  longer  appreciates  the  irritation,  or  does  so 
in  a diminished  degree.  The  irradiations,  which  would  otherwise 
have  been  reflected  to  every  part  of  the  economy  consequently 
cease,  and,  by  the  simple  arrest  of  morbid  sympathies,  the  amount 
of  disorder  is  diminished.  In  like  manner,  the  induction  of  sleep 
by  a full  dose  of  opium  will,  at  times,  allay  tumultuous  action  of 
the  nervous  and  vascular  systems,  which  could  not  have  persisted 
without  adding  to  the  amount  of  mischief. 

In  the  disease  of  colica  pictonum  we  have  a state  of  the  alimen- 
tary tube,  in  which  the  agency  of  opium  may  be  usefully  employed, 
with  the  view  of  removing  constipation.  This  is  often  dependent 
upon  irregular  action  of  the  nerves  distributed  to  the  muscular  fibres 
of  the  intestines,  — a state,  which  a combination  of  opium  with 
some  cathartic  — as  with  the  mild  chloride  of  mercury  — is  well 
calculated  to  remove.  The  opium  allays  the  inordinate  action  of  the 
nerves,  — resolves  the  spasm, — and  permits  the  mild  chloride  to 
exert  its  ordinary  cathartic  action.  For  reasons  like  these,  strength- 
ened by  the  results  of  experience,  a combination  of  calomel  with 
opium,  or  with  sulphate,  acetate,  or  muriate  of  morphia,  is  a com- 
mon prescription  with  many  practitioners  in  enteric  inflammation. 
In  most  of  the  London  hospitals,  it  may  be  regarded  as  an  'officinal 
formula. 

It  has  been  an  interesting  topic  of  inquiry,  — how  narcotics  exert 
their  constitutional  effects;  — that  is,  whether  by  the  impression  they 
make  on  the  nerves  of  the  part  with  which  they  come  in  contact  — 
such  impression  being  conveyed  to  the  rest  of  the  nervous  system  — 
or,  whether  they  must  not,  in  every  case,  enter  the  blood-vessels, 
affect  the  nerves  distributed  to  the  inner  coat  of  the  vessels,  or  pass 
with  the  current  of  the  circulation  to  the  great  nervous  centres.  There 
are  many  facts,  which  may  be  adduced  in  favour  of  each  of  these 
views.  As  regards  the  first,  one  of  the  strongest  arguments  is,  the 
rapidity  with  which  the  effects  of  certain  narcotics  are  induced.  Of 
these,  perhaps  the  most  marked  is  an  agent,  which  the  author  has 
classed  amongst  the  sedatives,  but  which  has  been  placed,  by  many 
toxicologists,  amongst  the  narcotics  — hydrocyanic  acid.  The 
effects  of  this  acid  have  been  examined  by  numerous  observers. 


336 


NARCOTICS. 


Magendie  asserts,  that  if  a single  drop  be  put  into  the  throat  of  a dog, 
the  animal  makes  two  or  three  deep,  hurried  respirations,  and  in- 
stantly drops  down  dead  ; that  it  causes  death  almost  as  instantane- 
ously when  dropped  under  the  eyelid  ; and  that  when  it  is  injected 
into  the  jugular  vein,  the  animal  falls  dead  at  the  very  instant,  as  if 
struck  with  a cannon-ball  or  with  lightning.  “ In  repeating  these 
experiments,”  says  Dr.  Christison,  “ in  order  to  determine,  figura- 
tively, the  shortest  period,  which  elapses  before  the  poison  begins  to 
operate,  as  well  as  the  shortest  time  in  which  it  proves  fatal,  I found 
that  a single  drop  weighing  scarcely  a third  of  a grain,  dropped  into 
the  mouth  of  a rabbit,  killed  it  in  83  seconds,  and  began  to  act  in 
63  seconds,  — that  three  drops,  weighing  four-fifths  of  a grain,  in  like 
manner  killed  a strong  cat  in  thirty  seconds,  and  began  to  act  in  ten, 
— that  another  was  affected  by  the  same  dose  in  five,  and  died  in 
forty  seconds,  — that  four  drops  weighing  a grain  and  a fifth  did  not 
affect  a rabbit  for  twenty  seconds,  but  killed  it  in  ten  seconds  more,  — 
and  that  twenty-five  grains,  corresponding  with  an  ounce  and  a half 
of  medicinal  acid,  began  to  act  on  a rabbit  as  soon  as  it  was  poured 
into  its  mouth,  and  killed  it  outright  in  ten  seconds  at  farthest.  Three 
drops,  projected  into  the  eye,  acted  on  a cat  in  twenty  seconds,  and 
killed  it  in  twenty  more  ; and  the  same  quantity,  dropped  on  a fresh 
wound  in  the  loins,  acted  in  forty-five,  and  proved  fatal  in  a hundred 
and  five  seconds.” 

Again,  the  empyreumatic  essential  oil  of  tobacco,  as  well  as 
strychnia,  has  caused  death  in  two  minutes. 

Now,  in  the  case  of  hydrocyanic  acid  especially,  which  proves 
fatal  in  a large  dose,  even  before  the  animal  can  be  removed  from 
the  lap  of  the  experimenter,  it  seems  difficult  to  offer  any  other  ex- 
planation, than  that  its  effects  are  exerted  upon  the  nervous  radicles 
with  which  it  is  made  to  come  in  contact,  and  that  thence,  with  the 
rapidity  of  lightning,  the  lethiferous  influence  is  propagated  to  the 
brain,  which  dies  first,  and,  in  due  succession,  all  the  functions, 
under  its  presidency,  cease.  Dr.  Christison,  indeed,  when  treating 
of  opium,  affirms,  that  “ the  old  doctrine,  that  the  blood-vessels  have 
no  concern  with  its  action,  and  that  it  acts  only  by  the  conveyance 
along  the  nerves  of  a peculiar  local  torpor  arising  from  its  direct  ap- 
plication to  their  sentient  extremities,  has  been  long  abandoned  by 
most  physiologists  as  untenable.  But  some  have  adopted  a modi- 
fication of  this  doctrine,  by  supposing,  that  opium  may  act  both 
by  being  carried  with  the  blood  to  the  brain,  and  by  the  transmission 
of  the  local  torpor  along  the  nerves.  They  believe,  in  fact,  that  opium 
possesses  a double  mode  of  action,  through  sympathy,  as  well  as 
through  absorption.”  ‘‘  It  would  bo  fruitless,”  he  adds,  ‘‘  to  inquire 
into  the  grounds  that  exist  for  adopting  or  rejecting  this  doctrine, 
because  sufficient  facts  are  still  wanting  to  decide  the  controversy. 
So  far  as  they  go,  however,  they  appear  adverse  to  the  supposition 
of  a conveyance  of  impressions  along  the  nerves,  without  the  previous 
entrance  of  the  poison  within  the  blood-vessels.” 


MODUS  OPERANDI. 


337 


All  the  difficulties,  in  the  way  of  the  theory  of  the  sympathetic 
action  of  opium,  Dr.  Christison  thinks,  are  removed  by  the  doc- 
trine of  Messrs.  Morgan  and  Addison.  According  to  this,  the  ex- 
periments, which  appear  at  first  sight  to  prove,  that  opium  ope- 
rates by  being  carried  with  the  blood  to  the  part  on  which  it 
acts,  are  easily  explained  by  considering,  that  the  opium  makes 
a peculiar  impression  on  the  inside  of  the  vessels,  which  impression 
subsequently  passes  along  the  nerves  to  the  brain.  In  the  case  of 
hydrocyanic  acid,  however,  the  imbibition  must  take  place  most 
rapidly,  as  the  deadly  results  supervene  so  immediately  on  its  appli- 
cation. Its  penetrating  power  must  largely  exceed  that  of  other 
narcotic  agents,  which  require  a long  time  before  their  effects  are 
perceptible.  Its  action  obviously  can  only  be  accounted  for,  by  pre- 
suming, that  its  impression  is  made  on  the  nerves,  either  of  the  part, 
or  of  the  interior  of  the  blood-vessels  : there  is  not  time  for  the  poison 
to  pass  to  the  nervous  centres  with  the  circulatory  current,  and  the 
experiment  of  Magendie  — which  showed  that  death  supervened  on 
the  very  instant  when  the  acid  was  injected  into  the  blood-vessels, 
whilst  a few  seconds  elapsed  before  its  fatal  action  was  exerted  when 
it  wa^  put  in  contact  with  an  absorbing  surface  — would  favour  the 
notion  of  Messrs.  Morgan  and  Addison,  that  the  impression  is  made 
on  the  nerves  distributed  to  the  inner  coat  of  the  blood-vessels, 
although  the  difficulty  remains,  why  these  nervous  filaments  should 
be  more  impressible  to  poisons  than  the  nervous  radicles  distributed 
to  the  external  dermoid  or  other  tissues.  If,  however,  the  view  of 
these  gentlemen  be  the  true  one,  it  must  persist,  whatever  may  be  the 
difficulty  in  suggesting  a satisfactory  explanation  of  the  phenomena. 

It  is  proper  to  bear  in  mind,  in  this  investigation,  that  many  agents 
of  the  class  now  under  consideration  do  jjroduce  impressions  on  the 
nerves  of  the  part  to  which  they  are  applied,  without  the  general 
system  being  materially  implicated  ; — a circumstance,  which  would 
favour  the  views  of  those,  who  consider  it  indispensable,  that  poisons 
should  enter  the  blood-vessels,  in  order  that  they  may  act  on  the 
general  system.  Robiquet  remarked,  that  when  the  vapour  of  con- 
centrated hydrocyanic  acid  was  confined  for  some  time  in  a glass 
tube,  with  a finger  on  each  open  end,  the  point  of  the  finger  became 
benumbed,  and  remained  so  for  more  than  a day.  Dr.  Wilson  Philip 
found,  that  when  opium  was  applied  to  the  mucous  coat  of  the  intes- 
tines of  a living  rabbit,  the  muscular  contractions  of  the  gut  were 
immediately  paralysed,  without  the  general  system  being  affected  for 
some  time.  The  same  effect  was  observed  by  Messrs.  Morgan  and 
Addison  to  follow  the  application  of  ticunas  to  the  intestine.  An 
instantaneous  and  total  suspension  of  the  peristole  took  place  when- 
ever the  poison  touched  the  gut.  Dr.  Monro,  secandus,  found,  when 
an  infusion  of  opium  was  inserted  between  the  skin  and  muscles  of 
the  leg  of  a frog,  that  the  leg  soon  became  paralysed,  whilst  the  ani- 
mal was  able  to  leap  about  briskly  on  the  other  three. 

Many  similar  examples  of  purely  local  impression  might  be  men- 
voL.  I. — 29 


338 


NARCOTICS. 


tioned,  were  it  necessary.  The  singularity  is,  that  the  general  system 
should,  in  these  cases,  remain  intact.  A striking  instance  of  purely 
local  action,  and,  at  the  same  time,  of  that  inexplicable  preference, 
of  which  we  have  so  many  examples,  in  the  influence  exerted  by 
various  agents  on  the  economy,  is  the  effect  of  some  of  the  class  of 
narcotics  in  dilating  the  pupil.  This  is  done  by  the  extracts  of  bel- 
ladonna and  stramonium,  without  the  general  nervous  system  being 
in  the  least  implicated;  whilst  the  most  energetic  of  the  narcotics  — 
opium  — exhibits  no  such  preference  of  action  on  these  nerves. 

There  can  be  no  doubt,  then,  that  narcotics  may  affect  the  frame 
through  the  medium  of  the  nerves,  without  its  being  necessary,  that 
they  should  proceed  with  the  blood  to  the  great  centres  of  the 
nervous  system  ; but  there  are  strong  facts  to  show,  that,  in  certain 
cases,  they  are  absorbed,  and  act  through  the  medium  of  the  circu- 
lation. Still,  as  has  been  suggested  by  Dr  A.  T.  Thomson,  such 
absorption  would  seem  to  be  by  no  means  essential.  The  strongest 
arguments  in  favour  of  it  — as  properly  stated  by  Dr.  Thomson  — 
are  : First.  The  time  that  supervenes  between  taking  a dose  of  opium 
and  the  manifestation  of  its  influence  on  the  system  — a time  suffi- 
cient, certainly,  for  the  absorption  of  the  narcotic  ; but,  in  reply  to 
this  argument,  he  states,  that  the  intimate  combination  of  the  meconate 
of  morphia,  with  the  other  constituents  of  the  drug,  requires  some 
time  before  it  can  be  so  far  separated  as  to  be  able  to  act  wdth  energy 
on  the  sentient  extremities  of  the  nerves  of  the  stomach  : for  “ we 
find,”  he  adds,  ‘‘  that  the  time,  which  supervenes,  is  in  the  direct 
ratio  of  the  state  of  solution  and  separation  from  the  other  constituents 
of  the  opium,  in  which  the  meconate  exists  in  the  preparation  em- 
ployed.” But  this  explanation  is  unsatisfactory.  When  taken  in  a 
soft  pill,  opium  produces  its  effects  almost  as  soon  as  when  any  of 
its  forms  rof  preparation  are  administered.  It  has,  indeed,  been  main- 
tained, that  this  is  not  the  fact,  but  the  very  cases  adduced  are  such 
as  establish  the  affirmative  of  the  position.  In  a case,  related  by  M. 
Desruelles,  the  sopor  was  fairly  formed  in  fifteen  minutes,  after  two 
drachms  of  solid  opium  had  been  taken.  Secondly.  The  increase  of 
the  symptoms,  for  ten  or  twelve  hours  after  their  inception,  although 
the  opium  is  as  much  in  contact  with  the  nerves  in  the  first  quarter 
of  an  hour,  as  at  the  end  of  the  twelve  hours.  This  argument.  Dr. 
Thomson  observes,  is  more  difficult  to  answer  than  the  first,  and  his 
opinion  is,  that  it  certainly  indicates  absorption.  This  is  probable  ; 
but,  under  any  view,  it  is  somewhat  strange,  that  the  augmentation 
should  continue  so  long;  and  the  supporters  of  the  doctrine,  which 
holds,  that  the  effect  must  take  place  through  the  medium  of  the 
nerves,  might  suggest,  with  much  speciousness,  that  such  effect  is  as 
easily  explicable,  on  the  idea  of  the  repetition  of  narcotic  impressions 
made  b>  fresh  and  fresh  portions  of  the  narcotic  coming  in  contact 
with  the  nerves  distributed  to  the  inner  coat  of  the  blood-vessels,  as 
by  the  view,  that  the  narcotic  must  pass,  with  the  blood,  to  the  ner- 
vous centres  themselves.  Thirdly.  The  rapid  effects,  which  follow 


MODUS  OPERANDI. 


339 


the  injection  of  opium,  in  solution,  into  the  veins  ; and  not  opium 
only,  but  any  of  the  narcotics.  Orfila  found,  that  an  ounce  of  the 
extract  of  the  leaves  of  conium  maculatum  killed  a dog  in  forty-five 
minutes.  Ninety  grains,  inserted  into  a wound,  killed  another  dog 
in  an  hour  and  a half;  and  twenty-eight  grains,  injected  into  a vein, 
killed  another  in  two  minutes.  It  is,  therefore,  legitimately  inferred, 
that  these  substances  act  by  entering  the  blood-vessels ; but  even 
granting  this,  it  does  not  follow  — ' as  the  author  has  endeavoured  to 
show  — that  the  substance  must  pass  with  the  blood  to  the  great 
nervous  centres.  It  may  act  on  the  nerves  of  the  inner  coat  of  the 
veins.  Indeed,  the  short  time  that  elapses,  prior  to  the  supervention 
of  the  narcotic  effects,  when  the  poison  is  injected  into  the  blood- 
vessels, is  somewhat  unfavourable  to  the  doctrine  of  the  necessity  of 
direct  contact  with  the  great  centres  of  the  nervous  system. 

But  there  are  facts  which  show  incontrovertibly,  that  opium  may 
enter  into  the  fluid  of  the  circulation.  During  the  confinement  of 
the  lady  of  a friend  of  the  author,  it  was  considered  necessary  to 
administer  morphia  to  her ; when  the  infant  became  so  completely 
narcotised,  that  serious  apprehensions  were  entertained  for  its  safety. 
It  ultimately  recovered.  A similar  case  is  given  by  Barbier.  The 
infant  was  manifestly  affected  through  the  milk  of  the  mother,  who 
had  taken  a large  dose  of  the  wine  of  opium.  In  these  instances, 
the  narcotic  must  have  passed  into  the  circulation  of  the  mother,  and 
been  separated  by  the  mammae.  We  are  compelled,  therefore,  to 
admit,  that  opium  may  commingle  with  the  blood  in  the  vessels,  and 
even  if  it  be  not  admitted,  that  it  proceeds  to  the  great  nervous  cen- 
tres,— there  to  exert  its  appropriate  influence, — it  maybe  con- 
ceived, that  by  coming  in  contact  with  the  nerves  distributed  to  the 
coats  of  their  blood-vessels,  it  may  produce  a more  powerful  effect 
upon  the  nervous  system,  than  if  its  action  were  wholly  exerted  on 
the  inner  coat  of  the  vessel,  into  which  it  first  passes. 

With  these  facts,  it  is  impossible  to  arrive  at  any  single  exclusive 
deduction.  It  would  seem,  that  narcotics  may  exert  their  effects 
upon  the  nerves  of  a part  of  the  dermoid  surface,  and  on  those  dis- 
tributed to  the  inner  coats  of  the  blood-vessels ; and  that  they  may 
pass  into  the  current  of  the  circulation,  and  proceed,  with  it,  to  exert 
what  precise  agency  is  not  so  clear. 

Dr.  A.  T.  Thomson  has  affirmed,  that  the  nerves,  more  particu- 
larly affected  by  narcotics  and  sedatives,  are  the  respiratory  ; — but 
it  is  not  easy  to  see  how  he  attains  this  conclusion.  He  quotes,  in 
confirmation  of  the  opinion,  a series  of  experiments,  conducted  by 
Sir  Benjamin  Brodie,  who  introduced,  in  one  instance,  a drop  of 
volatile  oil  of  bitter  almonds  into  a wound  in  a rabbit:  after  five 
minutes,  respiration  had  ceased ; but  the  heart  ‘‘  was  still  beating 
through  the  ribs;”  and,  by  renewing  and  keeping  up  respiration, 
by  artificial  means,  for  sixteen  minutes,  spontaneous  breathing  was 
re-established ; all  the  functions  of  the  brain  revived,  and  life  was 
in  fact  restored.  Dr.  Thomson  adds  — It  is  not  easy  to  explain, 


340 


NARCOTICS. 


why  one  set  of  nerves  should  be  more  particularly  influenced  than 
another  by  narcotics.”  This  case  does  not,  however,  appear  to  be 
in  point.  There  is  a marked  difference  between  the  voluntary,  the 
excito-motory,  and  the  organic  nervous  systems.  The  voluntary 
muscles  are  under  the  presidency  of  the  first : — the  involuntary, 
under  that  of  the  second,  and  probably  of  the  third  : the  respiratory 
organs  are  supplied  by  encephalic  nerves,  as  well  as  by  the  true 
spinal  or  excito-motory,  and  by  ganglionic  nerves:  but  the  heart  is 
singularly  situate  as  regards  its  nerves.  Although  capable  of  being 
affected  through  them,  its  action  may  continue  after  the  great  ner- 
vous centres  have  been  destroyed  — provided  it  receives  its  ordi- 
nary stimulus,  by  the  maintenance  of  artificial  respiration.  When, 
however,  the  cerebro-spinal  axis  is  destroyed,  the  mechanical  phe- 
nomena of  respiration  necessarily  cease. 

In  like  manner,  if  the  functions  of  the  brain  be  suspended  by 
the  action  of  a powerful  narcotic,  the  respiratory  phenomena,  which 
are  dependent  upon  the  influence  of  the  brain,  are  suspended  also  ; 
and  if  the  action  of  the  narcotic  be  fleeting,  we  may  conceive,  that, 
by  keeping  up  the  mechanical  phenomena  of  respiration,  and  thus 
maintaining  the  heart  in  action,  as  the  influence  of  the  narcotic  passes 
away,  the  encephalon  may  resume  its  wonted  functions,  and  respira- 
tion be  completely  re-established.  An  interesting  case  of  the  kind  has 
been  recorded  by  Dr.  Casper  Morris,  of  Philadelphia.  The  experi- 
ments of  Sir  Benjamin  Brodie  ought,  therefore,  to  be  borne  in  mind; 
and  although,  in  the  case  of  narcotics,  whose  action  is  prolonged, 
no  useful  hint  may  be  derived  from  them  of  a therapeutical  nature, 
yet,  as  has  been  said  before,  where  a narcotic  has  been  taken,  whose 
action  is  transitory,  the  recollection  of  them,  and  a due  acquaintance 
with  the  physiological  inferences  deducible  from  them,  may  lead 
to  the  preservation  of  a life,  which,  otherwise,  might  have  been 
lost. 

Narcotics,  then,  may  be  used  as  excitants,  or  as  sedatives.  Gene- 
rally, they  are  employed  to  diminish  impressibility,  and  to  allay  ex- 
citement ; and  a knowledge  of  their  medicinal  properties  enables 
us  to  administer  them  even  when  high  inflammatory  action  may  be 
present.  The  case  of  severe  headache  supervening  on  great  loss  of 
blood  from  the  uterus  was  before  selected  with  the  view  of  pointing 
out  the  difference  that  may  exist  between  hypersemise  of  various 
kinds.  It  was  then  remarked,  that  a few  hours  after  blood  has 
been  lost  to  an  inordinate  extent  by  this,  as  well  as  by  other  he- 
morrhages, the  nervous  impressibility  may  be  irregularly  developed, 
and,  under  the  erethism  of  the  nerves  distributed  to  particular  blood- 
vessels, these  vessels  assume  augmented  action,  and  evidences  pre- 
sent themselves  in  the  circulatory  movement,  which  appear  to  indi- 
cate the  existence  of  vascular  force  and  repletion  ; and  that,  in  all 
such  pathological  conditions,  the  indication  cannot  be, — to  draw  more 
blood  from  a system  already  exhausted,  as  far  as  is  compatible  with 
the  persistence  of  life.  On  the  contrary,  it  must  clearly  consist  in 


USED  AS  EXCITANTS  AND  SEDATIVES. 


341 


allaying  that  irritability  of  the  nervous  system,  which  has  been  so 
inordinately  developed  ; and  the  best  mode  to  accomplish  this  is  to 
administer  a full  sedative  dose  of  opium,  under  the  action  of  which 
tlie  nervous  and  vascular  turmoil  rapidly  subsides  into  a state  of 
quietude. 

It  is  astonishing  to  what  an  extent  narcotics  may  be  borne  with 
impunity,  where  a habit  of  resistance  has  been  acquired  by  long 
protracted  indulgence.  Dr.  Russel,  in  his  ‘ History  ofAleppo^^  states, 
that  a Turk  of  the  name  of  Mustapha  Shatar  — ^ an  opium  eater  in 
Smyrna  — took  daily  three  drachms  or  180  grains  of  opium  ; and 
in  the  ‘ Confessions  of  an  English  Opium  Eater,'*  the  author  of  that 
work  is  affirmed  to  have  consumed,  at  one  time,  eight  thousand 
drops  of  laudanum,  daily.  If  we  consider,  that  25  drops  of  lauda- 
num are  equal  to  one  grain  of  opium,  this  would  make  320  grains, 
or  upwards  of  five  drachms,  in  the  day.  In  a case  of  cancer  of  the 
uterus,  treated  by  Drs.  Monges  and  La  Roche  of  Philadelphia,  the 
quantity  of  laudanum  was  gradually  increased  to  three  pints  in  the 
24  hours,  besides  a considerable  quantity  of  solid  opium. 

Besides  the  physical  agents,  classed  under  the  head  of  narcotics, 
there  are  certain  moral  influences,  which  may  be  placed  in  the 
same  division.  These  have  been  termed  mental  narcotics  ; and 
it  has  been  properly  ren^arked  b}’  Dr.  A.  T.  Thomson,  that  ‘‘  persons, 
who  are  endowed  with  great  nervous  sensibility,  are  for  the  most 
part  powerfully  affected  by  mental  pleasures  and  pains ; and,  there- 
fore, when  the  higher  orders  of  society  and  men  of  intellectual  ac- 
quirements are  affected  by  mental  diseases,  it  is  sometimes  neces- 
sary to  employ  mental  narcotics,  when  material  substances  fail  in 
procuring  repose.”  Perhaps,  however,  in  all  cases,  such  mental 
operations  are  wholly  of  a revellent  kind  ; and  sleep  ensues  by  the 
mind  being  diverted  from  trains  of  thought,  or  impressions,  which 
prevented  it.  Impressions,  made  upon  the  nerves  of  audition,  have 
a soothing  effect,  more  than  those  on  any  of  the  other  senses.  It  is 
thus,  that  music  exerts  so  powerful  an  effect  on  the  frame,  — partly, 
perhaps,  by  the  mere  excitation  of  the  auditory  nerves,  and  partly, 

, also,  by  the  abstraction,  which  it  induces,  when  selected  so  as  to 
suit  the  precise  feeling.  Its  effect  upon  the  hearer  has  been  beau- 
tifully depicted  by  Dryden,  in  his  Alexander’’ s Feast ; and,  that  the 
picture  is  not  overdrawn,  must  be  admitted  by  all,  who  have  heard 
thepiece  well  read,  with  the  “ action  suited  to  the  word, ’’and, indeed, 
on  simple  perusal,  by  every  one,  whose  mind  is  attuned  to  the  live- 
lier sympathies. 

If  the  musical  air  be  lively,  and  varied,  the  attention  may  be 
kept  on  the  alert,  so  that  sleep  may  be  dispelled  ; but  if  its  charac- 
ter be  “ most  musical,  most  melancholy,”  and,  withal,  more  or  less 
monotonous,  sleep  is  almost  sure  to  ensue.  Armstrong — -himself 
one  of  the  profession  — has  well  described  the  effects  of  musip 
when  he  says : 

29^ 


342 


NARCOTICS. 


“ Music  exalts  each  joy,  allays  each  grief, 

Expels  diseases,  softens  every  pain.” 

But,  it  is  not  necessary,  that  the  intellectual  pleasure  of  music  should 
be  always  experienced,  when  the  object  is  to  restore  sleep  to  the  suf- 
ferer, or  to  one  who  is  in  health.  Any  succession  of  unvaried  sounds 
can  induce  it ; as  the  bubbling  of  a brook  ; the  purling  of  a rill ; the 
hum  of  a distant,  busy  multitude  ; a discourse  — however  interesting 
— delivered  in  a drawling  monotonous  manner;  the  clacking  of  a 
mill,  &c.  In  like  manner,  the  ballad  of  the  nurse,  with  the  rocking 
of  the  cradle,  soothes  the  restless  infant : with  the  same  view,  the  nurse 
scratches  its  back,  and  the  older  individual  is  often  recommended  to 
count,  over  and  over  again,  as  far  as  fifty  ; ■ — and  the  expedient  often 
succeeds.  The  mind  is  abstracted  from  the  thoughts  and  reflections 
that  occupy  it,  and  the  monotony  of  the  occupation  combines  to  accom- 
plish the  desired  result.  The  passes  and  other  manipulations  of  the 
animal  magnetiser  induce  a like  effect,  along  with  a series  of  singular 
and  anomalous  phenomena,  the  consideration  of  which  would  be  in- 
appropriate here. 

It  can  readily  be  conceived,  that  in  many  cases  of  insanity  appro- 
priate music  may  exert  a valuable  therapeutical  agency,  but  it  re- 
quires the  greatest  caution  on  the  part  of  the  practitioner  to  adapt 
it  to  particular  cases.  Lively  music  may  abstract  the  melancholic 
from  his  corroding  dejection  ; and  the  more  soothing  has  been 
known  to  produce  the  happiest  effects  on  the  furious  maniac.  To 
adapt  it  properly,  it  is  important  to  know  something  of  the  history 
of  the  patient,  lest  associations  of  a painful  character  should  be 
called  up,  which  might  vibrate  to  every  part  of  the  frame,  and  give 
rise  to  an  increase  of  the  aberration. 

Therapeutical  Application  of  JVarcotics. 

The  inquiry,  already  entered  into,  respecting  the  properties  of 
narcotics  as  medicinal  agents,  has  rendered  it  unnecessary  to  say 
much  concerning  their  therapeutical  application.  Allaying  pain, 
producing  sleep,  and  diminishing  action,  in  large  doses,  it  is  only 
in  such  doses  that  their  use  can  be  proper,  where  there  is  aug- 
mented vital  activity.  On  the  other  hand,  as  they  are  excitant  in 
small  doses,  they  must  be  exhibited  in  such  doses,  where  the  object 
of  the  physician  is  to  add  to  the  amount  of  excitation. 

Intermittents.  — In  intermittent  fevers,  they  are  occasionally  ad- 
ministered to  stop  an  anticipated  paroxysm  : this  effect  is  probably 
induced  by  the  new  action  they  occasion  on  the  nervous  system, 
which  breaks  in  upon  the  morbid  catenation  that  exists  in  these 
periodical  affections. 

Continued  and  remittent  fevers.  — In  continued,  and  remittent 
fevers,  when  narcotics  are  considered  to  be  indicated  by  extreme 
watchfulness  and  restlessness  at  an  early  period  of  those  diseases, 


THERAPEUTICAL  APPLICATION. 


343 


they  should  obviously  be  given  in  such  quantities,  that  their  seda- 
tive influence  may  be  fully  exerted  ; otherwise,  the  exaltation  of  the 
vital  manifestations  may  be  augmented  by  them.  The  author  well 
recollects,  at  the  period  when  he  followed  the  clinical  lectures  of 
the  late  Dr;  Home,  at  the  Royal  Infirmary  of  Edinburgh,  but  little 
hesitation  existed  as  regarded  the  administration  of  opium,  after 
the  ninth  day  of  a continued  fever  ; not  because  the  intelligent 
Professor  conceived,  that  there  was  philosophy  in  the  observance  of 
days,  but  because  it  had  appeared  to  him  that  prior  to  this  period 
— that  is,  during  the  first  week  of  the  disease  — the  beneficial  effects 
of  the  opiate  were  not  as  marked  as  they  were  afterwards.  The 
ordinary  dose,  directed  by  Dr.  Home,  was  thirty-five  drops  of  the 
tinctura  opii.  Pursuing  the  plan,  inculcated  by  him,  the  author  was 
in  the  habit  — early  in  practice  — of  waiting  until  about  the  com- 
mencement of  the  second  week,  and  then  of  prescribing  this  quan- 
tity, but,  as  he  became  better  acquainted,  from  experience,  with 
the  properties  of  the  drug,  and  with  the  pathological  conditions  pre- 
sent in  fever,  he  did  not  hesitate  — in  public  and  in  private  prac- 
tice — to  give  it  in  larger  doses,  and  even  at  an  early  period  of  the 
disease  ; and  he  is  not  prepared  to  say,  that  he  has,  in  a solitary 
instance,  observed  unpleasant  results  from  its  administration.  He 
generally  begins  with  40  or  50  drops,  in  the  case  of  the  adult,  or 
with  15  or  20  drops  of  the  black  drop,  or  with  one  of  the  prepara- 
tions of  morphia,  and  is  careless  as  to  the  precise  period  of  the 
complaint,  provided  symptoms  exist,  which  appear  to  him  to  indi- 
cate its  use. 

Injiammation^  spasmodic  diseases^  Sfc.  — Of  the  employment  of 
narcotics  in  the  different  phlegmasiee,  the  author  has  already  treated 
at  so  much  length,  that  it  is  not  necessary  to  add  any  thing  farther 
here. 

In  the  spasmi  of  Cullen,  and  in  some  of  the  vesanise,  they  are,  at 
times,  the  only  agents  that  afford  the  slightest  relief,  and  it  is  aston- 
ishing what  quantities  may  be  taken  without  the  supervention  of 
narcosis.  In  all  such  cases,  they  act  as  indirect  agents  belonging  to  the 
class  of  antispasmodics.”  In  delirium  tremens,  opiates  are  trusted 
to  solely  by  some,  but  they  are  rarely,  if  ever,  indispensable,  — the 
disease  generally  yielding  to  an  expectant  mode  of  management.  It 
would  be  endless,  however,  to  attempt  to  point  out  every  pathologi- 
cal state,  in  which  the  use  of  narcotics  may  be  indicated.  The 
practitioner  must  judge  for  himself,  and  if  he  understands  the  nature 
of  the  morbid  phenomena,  and  is  well  acquainted  with  the  medicinal 
properties  of  his  narcotic,  he  cannot  fail  to  know  where  its  employ- 
ment would  be  salutary  or  noxious.  The  object  of  this  work  is  to 
attempt  to  lay  down  great  general  principles  of  therapeutics,  and  to 
avoid  detail.  Of  the  evils  of  too  great  detail,  we  have,  indeed,  the 
most  marked  examples  in  some  of  the  existing  works  on  Thera- 
peutics and  Materia  Medica,  from  the  perusal  of  which  it  is  im- 
possible for  the  student  to  rise  with  other  feelings  than  those  of  con- 
fusion. 


344 


SPECIAL  NARCOTICS. 


SPECIAL  NARCOTICS. 

1.  O'PIUM. 

Opium  is  the  concrete  juice  of  the  unripe  capsules  of  Papa'ver 
somnif'erum.  The  process  for  procuring  it  is  much  the  same  in  all 
countries.  It  consists  in  making  incisions  into  the  capsules,  and 
collecting  the  juice  that  exudes.  Its  name  — from  o^ro?,  “juice,” 
sufficiently  indicates  its  nature.  The  poppy  is  cultivated  in  various 
countries,  but  especially  in  Asia  Minor,  Hindusthan,  and  Egypt;  and 
opium  is  collected,  although  not  to  much  extent,  in  Europe.  In  fact, 
the  price  at  which  Turkey  opium  can  be  imported  renders  it  an  un- 
profitable speculation. 

The  principal  varieties  of  opium,  met  with  in  commerce,  are  the 
Turkey^  the  Egyptian^  the  East  Indian^  the  Persian,  and  the  Eu- 
ropean. 

1.  Turkey  or  Levant  Opium  is  raised  in  Anatolia,  and  is  exported 
from  Smyrna  to  the  extent  of  about  400,000  lbs  ; hence  it  has  been 
called,  also,  Smyrna  opium.  It  is  produced  at  several  places,  from 
ten  to  thirty  days’  distance  in  the  interior ; but  that  grown  at  Caisar, 
about  600  miles  from  Smyrna,  is  said  to  be  most  esteemed.  It  comes 
to  the  United  States  either  directly  from  the  Levant,  or  indirectly 
through  some  of  the  ports  of  the  Mediterranean.  This  variety  of 
opium  is  said  to  be  beyond  comparison  the  most  abundant  in 
our  market,  and  it  is  that  from  which  the  ordinary  descriptions  of 
opium  are  drawn.  It  occurs  in  irregularly  rounded  or  flattened 
masses,  varying  in  size,  but  rarely  exceeding  two  pounds  in  weight, 
usually  surrounded  with  reddish  capsules  and  leaves  of  some  species 
of  rumex.  When  first  imported,  it  is  soft,  and  of  a reddish-brown 
colour;  but  becomes  hard  and  blackish  by  keeping.  Dr.  Wood 
states,  that  the  colour  of  the  finer  parcels  of  Smyrna  opium  is  light 
brown ; of  the  inferior  darker.  When  cut  into,  it  has  a waxy  lustre  ; 
and,  when  torn,  minute  shining  tears  are  observable,  seeming  to  show, 
that  the  masses  are  made  up  of  agglutinated  tears.  Although  this 
variety  would  appear  to  be  the  purest  met  with,  it  is  frequently 
largely  adulterated.  Dr.  Pereira  states,  that  from  one  sample, 
weighing  ten  ounces,  he  obtained  ten  drachms  of  stone  and  gravel. 
The  average  quantity  of  morphia,  that  can  be  obtained  from  it,  has 
been  estimated  by  Dr.  Pereira  at  about  8 per  cent.  Dr.  Wood 
affirms  that  good  Smyrna  opium  ought  to  yield  10  or  11  per  cent. 

A variety  is  imported  from  Turkey,  which  has  been  termed  Con- 
stantinople O'piUM.  Of  this  there  would  seem  to  be  two  sorts, — 
the  one  in  very  large  irregular  cakes,  which  is  of  very  good  quality, 
and  the  other  in  small  flattened  regular  cakes,  from  two  to  two  and 
a half  inches  in  diameter,  and  covered  with  the  poppy  leaf.  It  has 
a more  feeble  odour  than  the  other,  and  blackens  in  the  air.  The 
cakes  are  never  covered  with  the  rumex  like  the  Smyrna  opium, 
Constantinople  opium  is  much  inferior  to  Smyrna  opium,  but  supe- 


OPIUM. 


345 


rior  to  the  Egyptian.  Guibourt  states,  that  it  does  not  yield  more 
than  half  the  quantity  of  morphia  obtainable  from  Smyrna  opium  ; 
yet  there  is  great  discrepancy  in  the  statements  on  this  head,  suffi- 
cient to  lead  to  the  belief,  that  different  kinds  of  opium  are  taken  to 
Constantinople  and  exported  from  thence,  so  as  to  be  called  Con- 
stantinople opium. 

2.  Egyp'tian  Opium  is  only  of  recent  introduction  into  commerce, 
and  is  understood  to  be  one  of  the  products  of  the  agricultural  specu- 
lations of  the  present  Pacha  of  Egypt.  (Christison.)  It  is  imported 
in  round  flat  cakes,  weighing  from  four  to  eight  ounces,  and  wrapped 
up  in  some  leaf.  It  is  hard  and  dry;  of  a pale-brown  colour,  and 
waxy  lustre.  According  to  Guibourt,  it  affords  only  five-sevenths 
of  the  morphia  obtainable  from  Smyrna  opium.  By  another  experi- 
menter, Merck,  from  6 to  7 per  cent,  was  obtained  from  it,  and  it 
yielded  much  meconic  acid.  Another  specimen,  examined  by  Mr. 
J.  Evans,  of  Philadelphia,  afforded  only  3.55  per  cent.  It  is  evi- 
dently, therefore,  inferior  to  the  varieties  of  opium  already  consi- 
dered ; yet  some  of  it  would  appear  to  be  excellent : a specimen 
taken  from  a large  quantity,  that  was  purchased  for  Constantinople 
opium,  yielded  Dr.  Christison  rather  more  chlorohydrate  of  morphia 
than  average  opium  from  Smyrna.  It  would  appear,  according  to 
Dr.  Christison,  to  have  been  pretty  largely  imported  into  Great 
Britain  for  a few  years  past,  and  to  have  been  freely  purchased  at  a 
price  from  ten  to  twenty-five  per  cent,  under  that  of  fine  Smyrna 
opium ; although,  for  the  most  part,  more  inferior  than  in  proportion 
to  the  difference  of  price. 

3.  Indian  or  East  Indian  Opium.  Three  varieties  of  East  Indian 
opium  are  known  in  commerce, — the  Malwa,  the  Bena'res,  and  the 
Patna,  The  last  two  would,  however,  appear  to  be  undistinguish- 
able ; and  accordingly  they  are  considered,  by  most  pharmacologists, 
under  the  name  of  Bengal  opium.  Little  of  the  East  Indian  opium 
reaches  the  United  States. 

Bengal  opium  is  met  with  in  balls,  each  weighing  about  three 
pounds  and  a half,  packed  in  chests,  each  containing  about  forty 
balls,  which  are  hard,  and  consist  of  a case  about  half  an  inch  thick, 
and  half  a pound  in  weight,  formed  of  tobacco  leaves  and  aggluti- 
nated poppy  petals,  and  filled  with  a black  pitch-like  mass,  soft 
enough,  even  when  some  years  old,  to  be  taken  out  with  a spatula. 
According  to  Dr.  Pereira,  it  is  the  most  inferior  of  the  East  Indian 
opiums,  — not  containing  more  than  half  the  quantity  of  morphia 
procurable  from  good  average  Turkey  opium.  The  Benares  opium 
is  the  kind  prepared  by  the  Chinese  for  smoking,  and  its  con- 
sumption would  appear  to  be  enormous.  Prior  to  the  difficulties 
with  China,  the  sales  there  alone,  according  to  Dr.  Christison,  had 
rapidly  risen  to  the  amount  of  three  millions  of  pounds  avoirdupois, 
worth  about  as  many  pounds  sterling.  A variety  of  Bengal  opium. 


346 


SPECIAL  NARCOTICS. 


called  Garden  Patna  Opium,  results  from  an  improvement  in  the 
mode  of  preparing  it.  Dr.  Christison  states,  that  he  has  examined 
specimens,  which  were  little  inferior  to  average  Turkey  opium  in 
the  quantity  of  morphia  they  contained.  This  variety  is  not,  how- 
ever, known  in  commerce. 

Malwa  opium  has  usually  been  regarded  as  an  inferior  kind  of 
East  India  opium,  but  it  is  said  to  have  risen  greatly  in  value, 
and  to  be  now  highly  esteemed.  Dr.  Pereira  describes  two  varieties 
of  it ; the  one  in  round  flattened  cakes  or  balls,  weighing  ten  ounces  ; 
packed  in  a coarse  kind  of  chest,  composed  of  broken  poppy  petals; 
of  a dark  brown  colour ; homogeneous  texture  when  cut  into,  and  of 
an  odour  similar  to  that  of  Smyrna  opium  : — the  other  in  flattened 
cakes  without  any  outer  covering ; dull,  opaque,  of  a blackish-brown 
colour  externally,  and  somewhat  darker  and  soft  within;  having  an 
odour  something  like  that  of  Smyrna  opium,  but  less  powerful,  and 
combined  with  a slight  smoky  smell.  According  to  Guibourt,  it  fur- 
nishes not  more  than  one-third  of  the  morphia  obtainable  from 
Smyrna  opium. 

Under  East  India  opium.  Dr.  Pereira  describes  two  other  varie- 
ties — the  Cutch  opium  and  the  Kandeish  opium, ^ but  they  are  of  but 
little  interest  as  they  are  not  found  in  commerce. 

3.  Per'sian  Opium,  also  called  Treh'izon  Opium^  in  consequence 
of  its  being  imported  into  Europe  from  Trebizon  on  the  Black  Sea, 
is  in  the  form  of  cylindrical  sticks,  become  somewhat  angular  by 
pressure ; of  about  six  inches  in  length,  and  half  an  inch  — more 
or  less  — in  diameter ; enveloped  in  a smooth  shining  paper,  and 
tied  with  cotton.  It  is  soft  and  flexible,  and  does  not  become  hard 
even  when  kept  for  years.  It  is  of  a paler  brown  colour  than  any 
other  kind  ; and  of  a distinctly  granular  texture.  Its  taste  is  intensely 
bitter  ; and  it  is  of  very  inferior  quality.  Dr.  Christison  states  that, 
in  1834,  he  saw  in  the  London  Docks  many  large  chests  of  it,  which 
were  quite  unsaleable.  It  has  been  seen  in  this  country,  but  not 
often. 

4.  Europe'an  O'pium.  This  name  is  given  to  opium  which  has 
been  made  in  Great  Britain,  France,  Germany,  and  Greece.  It  can 
never  become  an  article  of  commerce,  in  consequence  of  the  low 
price  at  which  foreign  opium  can  be  imported.  Some  that  was 
raised  by  Dr.  Young  of  Edinburgh  closely  resembled  in  its  cha- 
racters the  Egyptian  or  the  Malwa  opium,  excepting  that  it  was  in 
roundish  masses.  It  was  hard,  dry,  pulverisable,  of  a light  brown 
colour,  shining  and  perfectly  homogeneous,  and  brought  a better  price 
in  the  market  than  fine  Turkey  opium.  From  some  prepared  by 
Messrs.  Cowley  and  Staines  7.57  per  cent,  of  morphia  were  obtain- 
ed. Another  specimen  of  British  opium  yielded,  however,  only  4.4 
per  cent. 

The  opium  made  in  France  is  described  by  Pelletier  as  of  a deep 


OPIUM. 


347 


reddish  brown  colour,  and  brittle  when  dry  ; yielding  in  some  spe- 
cimens a considerable  per  centage  of  morphia,  — according  to  Pel- 
letier 10.38  per  cent.  German  opium,  prepared  from  the  purple 
poppy,  Papaver  somniferum  — var.  nigrurrij  yielded  likewise  a large 
percentage: — : according  to  Biltz  as  much  as  20  per  cent.  It  is 
doubtful,  however,  whether  these  estimates  can  be  used  compara- 
tively, as  we  have  no  evidence  that  the  morphia  in  all  the  cases 
was  equally  pure. 

The  physical  properties  of  opium  are  generally  taken  from  the 
Smyrna  opium.  There  are  certain  qualities,  which  belong,  how- 
ever, more  or  less  to  all.  The  odour  is  strong,  peculiar  and  cha- 
racteristic in  all  the  varieties,  but  in  some  more  so  than  in  others. 
The  taste  is  very  bitter,  and  somewhat  pungent,  exciting  irritation 
in  the  lips  and  tongue  when  chewed  for  any  length  of  time.  The 
best  opium  does  not  undergo  any  change  by  keeping,  excepting  that 
it  becomes  harder;  and  this  change  it  is  important  to  bear  in  mind, 
inasmuch  as  there  must  be  great  diversity  in  the  strength  according 
to  the  degree  of  dryness  ; hence,  some  of  the  Colleges  have  di- 
rected, that  the  preparations  of  opium  shall  be  made  from  the  pow- 
deY.  Some  of  the  coarser  kinds  of  Turkey  opium,  and  the  common 
Bengal  variety  in  balls,  are  apt  to  become  mouldy  after  a time  ; and 
the  latter,  as  well  as  Persia  opium,  never  seems  to  harden  thoroughly 
under  exposure  to  the  air,  which  has  been  supposed  to  be  owing  to 
the  admixture  of  oil.  (Christison.)  When  thoroughly  dried,  it  can 
be  reduced  to  powder,  but  as  it  attracts  moisture  from  the  air,  and 
becomes  lumpy,  the  powder  should  be  kept  in  well  stopped  bottles. 

The  quantity  of  opium  used  in  various  parts  of  the  world  is  as- 
tonishing. Allusion  has  already  been  made  to  that  consumed  by 
the  Chinese  prior  to  the  late  interdiction  of  its  use.  In  England, 
the  quantity,  on  which  duty  was  paid  in  the  year  1841,  was,  accord- 
ing to  Dr.  Pereira,  37,960  pounds  ; and  in  the  year  preceding,  it  was 
45,589  pounds;  the  greater  part  of  which  was  imported  from  Tur- 
key. From  the  treasury  returns  of  the  United  States  for  the  year 
1829,  it  appears  that  the  value  of  opium  imported  from  the  Turkish 
dominions  was  92,924  dollars ; from  Mediterranean  France  12,187 
dollars,  and  from  every  other  part  of  the  world  2,040  dollars.  None 
was  imported  from  India.  (Wood  &Bache). 

Water  dissolves  about  two-thirds  of  Turkey  opium,  including  a 
great  proportion  of  its  active  ingredients  ; alcohol  nearly  four-fifths 
of  its  weight,  and  all  its  active  constituents.  Sulphuric  ether  dis- 
solves little  more  than  one  of  the  active  principles,  which  is  not  so- 
luble in  water  — the  narcotin  ; and  the  dilute  acids,  both  mineral 
and  vegetable,  entirely  exhaust  it  of  its  virtues.  It  contains  a great 
variety  of  principles,  and  has  received  much  attention  from  ana- 
lytical chemists,  from  whose  labours  it  results,  that  it  has  at  least  the 
following  constituents:  — morphia,  narcotin,  codeia,  narcein,  me- 
conin,  thebain  or  paramorphia[?],  pseudomorphia,  meconic  acid, 


348 


SPECIAL  NARCOTICS. 


brown  acid  extractive,  sulphuric  acid,  resin,  fat  oil,  gummy  matter, 
caoutchouc,  albumen,  odorous  principle  and  lignin.  The  most  im- 
portant of  these  are  morphia,  codeia,  and  narcotin,  of  which  the  first 
is  an  officinal  preparation,  and  will  be  described  hereafter.  They  are 
all  of  modern  discovery.  Of  the  six  crystalline  principles,  morphia, 
codeia,  and  paramorphia,  narcotin,  narcein,  and  meconin,  the  three 
first  are  alkaline,  and  the  others  neutral. 

Codeia  or  Co'deine,  the  preparation  of  which  is  given  by  the  au- 
thor elsewhere,  {JYew  Remedies^  4th  edit.  p.  170,  Philad.  1843,)  is  a 
white  crystalline  solid,  soluble  in  water,  alcohol  and  ether;  uniting 
readily  with  acids  ; and,  with  the  chlorohydric  especially,  forming 
a salt  which  crystallises  with  great  facility  ; 1000  parts  of  water,  at 
60°  Fahrenheit,  dissolve  12.6  parts  of  codeia:  the  same  quantity  at 
100°,  37  parts,  and  at  212°,  58  parts. 

The  experience  of  different  observers  on  the  effects  of  codeia  on 
the  economy  has  been  discordant.  Magendie  states,  that  it  causes 
sleep,  and,  in  large  doses,  stupor.  He  considers  one  grain  of  codeia 
equivalent  to  half  a grain  of  morphia.  Two  grains  often  excited 
nausea  and  even  vomiting.  A syrup^  each  ounce  containing  two 
grains  of  codeia,  has  been  given  in  hooping-cough,  and  in  other  dis- 
eases in  which  opium  has  been  found  useful ; and  it  has  been  found 
serviceable  by  Dr.  Miranda,  of  the  Havana,  in  cases  of  what  he 
terms  “ powerful  nervous  irritations  of  the  mucous  membrane  of 
the  stomach.”  The  chlorohydrate  has  been  used  in  Philadelphia, 
but  it  has  not  been  found  to  have  any  virtues,  not  equally  pos- 
sessed by  the  salts  of  morphia,  whilst  it  has  the  objection  that  the 
price  has  been  enormous — as  much  as  four  dollars  the  drachm. 

Nar'cotin  or  nar'cotine  is  commonly  procured  either  from  the 
aqueous  extract  of  opium  by  means  of  ether,  which  only  dissolves 
the  narcotin,  and,  consequently,  requires  but  to  be  evaporated  to 
obtain  it ; or  from  crude  opium,  which  has  been  exhausted  by  cold 
water.  It  may  hence  be  obtained  from  the  residue  after  the  prepa- 
ration of  the  aqueous  extract  of  opium  of  the  shops.  It  crystallises 
in  very  white  needles ; is  devoid  of  taste  and  smell ; neutral ; in- 
soluble in  water,  but  soluble  in  ether,  boiling  rectified  spirit,  and 
dilute  acids.  By  its  not  affecting  vegetable  colours,  it  is  readily 
distinguishable  from  both  morphia  and  codeia. 

The  views  in  regard  to  the  medical  properties  of  narcotin  have 
been  contradictory.  Magendie  was  of  opinion,  that  morphia  is  the 
sedative  or  anodyne  principle  of  opium,  — narcotin  the  exciting. 
Orfila,  on  the  other  hand,  entertained  various  notions  in  regard  to  it, — 
at  one  time  believing  it  to  be  inert ; at  another,  to  have  the  same  action 
as  morphia  ; and  at  another,  to  concur,  when  combined  with  morphia, 
in  the  properties  of  opium,  but  to  a slight  degree  only  — since  opium, 
deprived  of  narcotin,  is  not  less  deleterious  — and  to  possess  another 
modus  operandi  than  opium,  without,  however,  his  being  able  to 


OPIUM. 


349 


regard  it  as  the  exciting  principle.  Others  have  given  it  in  large 
doses  without  any  narcotic  ellect  having  been  induced  by  it ; and 
hence  it  has  been  imagined,  that  the  narcotin  of  the  earlier  experi- 
menters was  an  impure  article.  Owing  to  all  the  uncertainties  ap- 
pertaining to  it,  narcotin  is  but  little  employed  in  medicine.  It  would 
seem,  however,  that  the  exciting  properties  of  opium  do  not  belong 
to  it  exclusively,  for — as  elsewhere  remarked  — there  are  many 
persons  who  are  as  disagreeably  affected  by  morphia  alone  as  they 
are  by  opium,  which  contains  both  morphia  and  narcotin.  Recently, 
narcotin  has  been  employed  as  an  antiperiodic  in  the  treatment  of 
remittent  and  intermittent  fevers.  (See  Tonics.) 

The  other  constituents  of  opium  are  not  of  much,  if  any,  thera- 
peutical interest.  Narcein,  meconin,  pseudomorphia,  and  meconic 
acid  appear  to  be  inert,  and,  according  to  Magendie,  thebain  or 
paramorphia,  when  injected  into  the  jugular  vein,  or  placed  in  the 
pleura  of  an  animal,  causes  tetanus  and  death  in  a few  minutes. 

The  therapeutical  effects  of  opiates  in  different  doses  have  been 
briefly  referred  to  under  the  general  observations  on  the  class  of 
Narcotics.  That  they  are  excitant  in  a small  dose  is  admitted  by 
all ; and  that  they  are  sedative  in  a large  dose  is  equally  admitted  by 
most  observers.  A grain  of  opium,  which  is  an  ordinary  dose,  first 
of  all  excites  the  organic  actions,  but  this  excitement  is  followed,  in 
the  generality  of  cases,  and  in  a short  time,  by  sedation.  The  animal 
functions  are  likewise  exalted  along  with  the  organic,  so  that  sensi- 
bility and  muscular  motion  are  exerted  with  more  vigour;  but  this 
excitation  is  sooner  or  later  followed  by  a disinclination  to  movement, 
and  a decided  tendency  to  sleep.  Usually,  during  the  period  of 
excited  action,  the  mouth  is  dry  and  clammy,  and  the  individual 
therefore  thirsty;  the  appetite  is  impaired,  — the  secretions  and  peri- 
stole of  the  intestinal  canal  seeming  to  be  diminished,  so  that  con- 
stipation ensues.  Hence,  in  the  healthy  state  of  the  frame,  as  well 
as  in  certain  conditions  of  diarrhoea  and  dysentery,  small  doses  of 
opium  are  often  used  as  indirect  astringents.  When  larger  doses 
are  administered,  — say  from  two  to  three  grains,  or  more,  — the 
excitement  of  the  animal  and  organic  functions  may  still  be  percepti- 
ble in  the  first  instance  ; but  commonly  the  excitation  persists  for  a 
very  short  time,  and  is  succeeded  by  a marked  sedative  influence  and 
a state  of  dreaminess  followed  by  stupor,  and  ultimately  by  an  irre- 
sistible desire  to  sleep.  When  sleep  is  not  caused  by  it,  and  a full 
dose  has  been  taken,  the  patient  is  often  amused  — and  at  times 
annoyed  — with  the  multitude  of  fantastic  groups,  which  he  can 
frequently  call  up  at  pleasure.  In  many  cases,  when  the  effects  of 
the  opiate  pass  away,  more  or  less  disturbance  of  the  functions  of 
the  stomach  and  bowels  remains,  with  languor  and  listlessness. 

When  given  to  a still  greater  extent,  opium  and  its  preparations 
are  narcotic  poisons  ; they  are  the  types,  indeed,  of  the  class.  In 
such  large  doses,  no  signs  of  excitement  are  perceptible,  the  first 
evidences  of  the  poisonous  action  being  giddiness  and  stupor,  which 
VOL.  I. — 30 


350 


SPECIAL  NARCOTICS. 


rapidly  increase  so  that  there  is  a suspension  of  all  mental  and  moral 
manifestations,  — the  individual  appearing  to  be  in  a deep  coma, 
breathing  slowly  ; the  eyes  closed,  and  the  pupils  contracted.  Unless 
relief  is  obtained,  the  countenance  assumes  a ghastly  character,  the 
pulse  becomes  more  and  more  feeble,  the  muscles  are  exceedingly 
relaxed,  and  death  closes  the  scene.  Should  he  on  the  other  hand, 
recover  from  this  state  of  coma,  it  generally  passes  into  deep  sleep, 
which  usually  terminates  in  from  twenty-four  to  thirty-six  hours,  and 
is  followed  by  nausea,  vomiting,  giddiness,  and  loathing  of  food. 
(Christison). 

Opium  does  not  affect  all  persons  alike.  There  is  perhaps  no 
article  of  the  materia  medica,  which  disagrees  with  so  many  indi- 
viduals, or,  in  other  words,  which  so  often  produces  effects  on  the 
system  not  desired  by  the  physician ; and  frequently  there  is  a capri- 
ciousness in  this  respect,  which  is  as  strange  as  it  is  inexplicable  ; — 
opium  itself,  or  some  of  its  preparations  producing  disagreeable  im- 
pressions, whilst  congenerous  preparations  have  all  the  pleasant  and 
soothing  operation  that  is  desired.  These  disagreeable  phenomena 
are  — instead  of  sleep  or  a placid  condition,  — fever,  quick  pulse, 
headache,  restlessness,  watching  at  times,  delirium,  nausea  and 
vomiting.  They  are  considered  to  be — and,  doubtless,  usually  are 
— the  result  of  idiosyncrasy;  but  Dr,  Christison  asserts,  that  he 
has  known  them  induced  in  those  with  whom  opium  in  general 
agrees,  if  they  happened  to  take  it  in  too  large  a dose,  or  soon  after 
a full  meal  with  more  than  an  ordinary  allowance  of  wine.  Perhaps 
the  preparation,  that  is  the  least  likely  to  produce  these  results, 
is  the  muriate  or  one  of  the  other  salts  of  morphia : the  black  drop 
is,  also,  an  excellent  preparation  ; and  the  author  has  often  found  the 
Tinctura  Opii  camphorata^  and  the  Pulvis  Ipecacuanhce  compositus 
succeed,  when  opium  in  substance,  or  the  Tinctura  Opii^  could  not 
be  tolerated. 

In  regard  to  susceptibility  of  individuals  to  the  action  of  opiates, 
there  is  much  diversity.  Some  resist  large  quantities,  and  it  has 
been  shown,  (p.  341,)  that  by  habit  the  endurance  or  tolerance  be- 
comes astonishing.  Others,  on  the  contrary,  are  affected  by  the 
smallest  quantities.  This  has  to  be  discovered  by  observation  of 
particular  cases ; and  a single  dose  is  sufficient  to  communicate  the 
important  information.  It  is  essential,  however,  to  bear  in  mind, 
that  infants  are  extremely  impressible  to  its  action,  and  that  a drop 
of  laudanum  cannot  always  be  administered  with  safety  to  an  infant 
a few  weeks  old.  The  action,  too,  is  modified  according  to  the  sur- 
face to  which  it  is  applied.  The  full  effect  is  induced  w'hen  taken 
into  the  stomach.  When  thrown-  into  the  rectum,  the  general  rule 
is  to  give  it  in  three  times  the  quantity  that  would  be  administered 
in  the  same  case  by  the  mouth.  This  rule  has,  however,  been 
strongly  objected  to  as  one  of  universal  application,  and  there  may  be 
cases  in  which  the  practitioner  might  be  surprised  to  see  unusual 
effects  induced  by  it,  but  such  a case  has  never  fallen  under  the 


OPIUM. 


351 


author’s  observation.  ‘‘It  is  conceived”  — says  Dr.  Christison  — 
“ in  some  continental  countries,  especially  in  France,  that  it  acts 
three  or  four  times  more  energetically  through  the  rectum  than  by  the 
stomach.  This  must  be  an  error  ; for  in  Britain  it  is  not  uncommon 
to  give  sixty  minims  of  laudanum  or  four  grains  of  opium  by  the 
rectum,  — doses  which,  according  to  the  French  view,  ought  toocca- 
sion  always  alarming  symptoms,  and  sometimes  even  death.”  A safe 
plan  would  be,  to  inject  the  same  quantity — if  a full  dose  — as 
would  be  prescribed  by  the  mouth,  and  repeat  the  dose  every  half 
hour,  unless  its  effects  were  apparent. 

It  is  in  disease,  however,  that  we  witness  the  most  anomalous  re- 
sistance to  the  action  of  opium.  It  can  rarely  happen,  that  the  pa- 
tient is  rendered  more  impressible  to  it ; and  in  a large  class  of  dis- 
eases the  resistance  to  it  is  so  great,  that,  occasionally,  enormous 
doses  are  needed.  For  example,  in  spasmodic  affections,  such  as 
tetanus,  hydrophobia,  neuralgia,  — and  indeed  in  other  neuroses  — 
as  mania,  delirium  tremens,  &c.,  the  quantities  required  to  produce 
the  narcotic  effects  of  opium  are  often  enormous  ; and  even  when 
the  erethitic  condition  of  the  nervous  system  has  been  overcome,  no 
phenomena  may  exist  indicating  that  a narcotic  has  been  taken. 

When  applied  to  the  denuded  skin  or  endermically,  opiates  do  not 
act  as  energetically  on  the  system,  as  when  administered  by  the  mouth 
or  rectum  ; but  not  unfrequently,  where  opium  disagrees  with  the 
individual,  the  endermic  application  can  be  tolerated,  and  all  the 
beneficial  results  of  the  narcotic  be  obtained. 

The  effects  of  opium,  when  received  into  the  air  tubes  in  the  form 
of  smoke,  we  have  no  opportunity  for  observing,  except  in  the  way 
of  experiment.  By  the  Orientals,  it  is  employed  in  enormous  quan- 
tities. The  Chinese  use  an  aqueous  extract  for  this  purpose,  which 
they  term  Chandoo,  and  the  effects  would  appear  to  be  the  same  as 
when  swallowed  ; yet,  as  Dr.  Christison  has  remarked,  opium  is 
known  to  be  decomposed  by  such  a heat,  as  is  necessary  in  the  pro- 
cess of  smoking  a pipe,  and  none  of  its  active  principles  are  volatili- 
sable.  He  adds,  that  several  of  his  pupils  have  tried  the  process  with  a 
Chinese  pipe,  and  Chinese  extract,  but  experienced  no  other  effects 
than  severe  headache  and  sickness. 

The  remarks  made  as  to  the  therapeutical  application  of  narcotics 
apply  rigidly  to  opium  ; and  the  great  point  to  be  borne  in  mind  is, 
— the  difference  in  its  action  according  to  the  dose  in  which  it  is 
given;  excitant — as  we  have  seen  in  a small  dose;  sedative  in  a 
large. 

In  fever — as  elsewhere  remarked,  (p.  343) — it  is  beneficial 
under  numerous  conditions,  especially  where  there  is  insomnia, 
great  restlessness,  low  delirium  or  tremor.  Where  much  cerebral 
disturbance  exists,  it  has  been  advised  to  give  it  in  combination 
with  the  tartrate  of  antimony  and  potassa.  Still,  the  main  effective 
agent  is  the  opium.  Its  valuable  sedative  influence  renders  it  well 
adapted  for  many  inflammatory  diseases ; although,  at  one  time. 


352 


SPECIAL  NARCOTICS. 


when  its  modus  operandi  was  less  understood,  it  was  carefully 
avoided  in  those  diseases,  under  the  idea,  that  it  might  induce  un- 
due excitement.  Not  only  does  it  diminish  the  over-excited  or- 
ganic actions,  but  it  lessens  pain,  and  causes  sleep. 

After  blood-letting  has  been  employed,  a full  dose  of  opium  is 
often  one  of  the  most  precious  sedatives  that  can  be  prescribed.  In 
the  inflammations  of  the  lining  membrane  of  the  intestinal  canal, 
opium  is  a most  valuable  remedy.  In  simple  diarrhoea,  it  is  often 
employed  alone  or  associated  with  chalk  and  aromatics  ; in  ordinary 
cholera  morbus,  a full  dose  frequently  relieves  almost  instantaneously; 
and  in  dysentery,  its  combination  with  calomel  is  often  advantageous. 
In  too  great  secretion  from  the  mucous  membrane  of  the  bowels,  it 
allays,  by  its  sedative  agency,  the  inflammatory  or  other  irritation, 
and  thus  diminishes  the  secretion,  and,  at  the  same  time,  the  in- 
creased peristaltic  action.  In  encephalitis  alone,  doubt  might  exist 
as  to  the  propriety  of  its  administration,  and  some  have  pronounced 
it  to  be  positively  injurious  in  that  form  in  which  the  cerebral  sub- 
stance is  inflamed,  and  indeed  in  inflammation  of  the  parenchyma- 
tous tissue  of  organs  in  general ; but  although  more  caution  may  be 
required  in  encephalitis  in  its  administration,  there  is  little,  if  any, 
reason  for  the  belief,  that  it  is  injurious  in  parenchymatous  inflam- 
mation, provided  it  be  prescribed  with  a due  knowledge  of  its  pro- 
perties ; indeed,  it  has  been  before  shown,  (p.  331,)  that  in  pneu- 
monia, its  administration  is  often  attended  with  signal  advantage, 
when  given  in  appropriate  doses. 

In  acute  rheumatism  it  has  been  prescribed  largely,  and  with  much 
benefit,  both  alone,  and  when  associated  with  ipecacuanha ; and  a 
full  dose  often  arrests  an  ordinary  catarrh  or  inflammatory  sore  throat 
at  its  very  inception. 

In  the  various  neuroses,  it  has  been  copiously  administered.  In 
mania,  for  example,  the  excessive  excitement  has  been  overpowered 
by  full  doses  of  opiates  ; and  in  delirium  tremens,  it  has  been  by 
many  considered  almost  a sheet  anchor.  It  is,  however,  in  spasmo- 
dic diseases,  that  it  is  most  trusted  to.  In  every  variety  of  these,  it  is 
used  beneficially,  and  in  the  more  violent,  as  tetanus,  hydrophobia, 
&c.,  — although  too  often  insufficient — more  trust  is  reposed  in  it 
than  in  any  other  remedy.  But  it  is  almost  impracticable  to  point 
out  the  numerous  cases  in  which  this  invaluable  anodyne  and  hyp- 
notic is  capable  of  rendering  service.  A due  knowledge  of  its  pro- 
perties cannot  fail  to  suggest  those  in  which  its  operation  will  be 
beneficial. 

When  employed  topically,  it  is  chiefly  with  the  view  of  relieving 
pain,  although  its  anodyne  and  other  virtues  are  not  readily  exerted 
through  the  cuticle.  In  cases,  however,  in  which  there  is  cutaneous 
ulceration  or  abrasion  of  any  kind,  the  anodyne  effect  is  signally  ap- 
parent. It  is  prescribed  in  certain  cases  of  ophthalmia,  in  painful  ul- 
cerations of  all  kinds,  and  in  painful  chronic  cutaneous  diseases  ; and 
a recent  writer,  Dr.  Christison,  affirms  that  both  in  erythema  and  in  all 


OPIUM. 


353 


kind  of  erysipelas  — even  idiopathic  erysipelas  of  the  face  — the  best 
of  all  applications,  not  merely  for  allaying  pain,  but  likewise  for  ar- 
resting the  local  inflammatory  action,  is  a lotion  made  by  preparing 
an  infusion  of  32  grains  of  opium^  and  a solution  of  as  much  acetate 
of  lead^  each  in  four  ounces  of  water ^ then  mixing  the  solutions,  and 
filtering  the  mixture  to  separate  the  insoluble  meconate  of  lead.  Opi- 
ate frictions  have  likewise  been  used  in  chronic  rheumatism,  in  sprains, 
and  in  deep-seated  painful  affections  in  general,  no  matter  of  what 
character.  It  is  moreover  employed  in  similar  cases  in  form  of  plas- 
ter ; is  applied  to  the  bottom  of  a carious  tooth  ; and  added  to  the 
most  varied  topical  applications, — always,  however,  with  the  view 
of  allaying  pain  or  irritation. 

The  dose  of  opium  varies,  according  to  the  effect  which  it  is  de- 
sired to  induce.  As  an  excitant  narcotic,  it  may  be  given  to  the 
amount  of  a quarter  or  half  a grain.  To  induce  its  ordinary  anodyne 
and  hypnotic  effects,  the  dose  is  a grain  or  a grain  and  a half ; and  a 
full  dose,  capable  of  exciting  all  the  sedative  operation  of  the  nar- 
cotic, is  from  two  to  four  grains.  The  last  quantities  should  only  be 
given,  however,  where  pain  is  inordinate  ; spasm  severe  ; or  where 
a powerful  sedative  influence  is  needed  after  blood-letting.  It  is 
usually  prescribed  in  the  form  of  pill.  At  times  it  is  used  as  a sup- 
pository, — four  or  five  grains  being  formed  into  a cylinder  with  soap, 
and  introduced  into  the  rectum,  in  painful  affections  of  the  uterus  or 
rectum. 

PILTLiE  'O'PII,  PILLS  OF  OPIUM.  [Opii  pulv.  5j  ; Sapon.  gr.  xij  ; to 
be  divided  into  60  pills.)  Each  of  these  contains  a grain  of  opium  ; 
the  soap  serving  no  other  purpose  than  to  communicate  the  proper 
consistence. 

In  the  last  edition  of  the  Pharmacopseia  of  the  United  States,  an 
anagolous  formula  has  been  introduced  under  the  name  PIL'ULE  SAPO'- 
NIS  COMPOS'M,  or  COMPOUND  PILLS  OF  SOAP.  In  this,  half  an  ounce  of 
opium  in  powder  is  beaten  with  two  ounces  of  soap  so  as  to  form  a 
pilular  mass.  The  object  of  this  formula  is  to  have  an  opportunity 
of  prescribing  opium  in  cases  where  it  is  deemed  advisable  that  the 
patient  should  not  know  he  is  taking  it. 

CONFEC'TIO  O'PII,  CONFECTION  OP  O'PIIIM.  (Opii,  pulv.  3ivss ; Pulv, 
aromat.  jvj;  Mel.  despumat.  3xiv.)  This  is  a relic  of  the  old 
Philonium,  and  has  been  much  used  but  is  not  so  at  present. 

The  aromatic  powder,  associated  with  the  opium,  renders  it  an  ex- 
citant narcotic,  and  adapted  for  cases  of  flatulent  colic,  and  for  atony 
of  the  digestive  organs.  It  is  most  frequently,  perhaps,  prescribed  in 
cases  of  diarrhoea  unaccompanied  by  vascular  excitement.  When 
added  to  cinchona  or  to  sulphate  of  quinia,  it  is  said  to  increase 
greatly  their  efficacy  in  obstinate  intermittents.  About  36  grains  of 
the  confection  contain  one  grain  of  opium. 

TINCTU'RU  O'PII,  TINCTURE  OF  O'PIUM.  {Opii,  pulv.  siiss;  McohoL 
30^ 


354 


SPECIAL  NARCOTICS. 


dilut.  Oij.)  Laudanum — for  so  the  tincture  of  opium  is  commonly 
termed — is  more  frequently  used  than  any  other  preparation  of  opium, 
and  this  mainly  owing  to  the  facility  with  which  it  can  be  given. 

About  one  grain  of  opium  may  be  contained  in  about  thirteen 
minims  of  the  tincture,  although  it  is  not  easy  to  fix  upon  the  exact 
proportion.  Twenty-five  ordinary  drops  are  generally  regarded  as 
equivalent  to  a grain  of  opium. 

The  dose  varies  from  twenty-five  drops  to  a hundred.  The  tinc- 
ture should  always  be  clear.  When  not  so,  it  is  owing  to  the  depo- 
sition of  opium,  which  may  add  materially  to  the  strength,  if  it  be 
shaken. 

TENCTU'RA  0 Til  ACETA'TA,  AC'TTATEB  TINC  TURE  OF  O PIUM.  ( Opii,  §ij ; 
Acetij  f.  gxij  ; Alcohol.  Oss.)  This  preparation  is  prescribed  in  the 
same  cases  as  the  Acetum  opii  or  black  dj^op.  Its  dose  is  ten  minims, 
or  about  twenty  drops,  which  are  considered  to  be  equivalent  to  a 
grain  of  opium. 

TINCTU'RA  O'PII  CAMPIIORA'TA,  CAMPH  ORATED  TINCTURE  OF  O'PIUM.  ( Opn, 
pulv.  ; Acid.  Benzoic,  aa  5i;  01.  anisi,  f.  ^i;  Mel.  despumat.  jij  ; 
Cajnphor.  ^ij ; Alcohol,  dilut.  Oij.)  This  is  the  well  known  Pare- 
goric Elixir  ^ much  used  in  popular  practice.  It  is  an  agreeable  pre- 
paration, owing  to  the  aromatic  and  saccharine  additions,  which  like- 
wise cause  it  to  agree,  at  times,  with  persons  when  the  tincture  of 
opium  cannot  be  tolerated.  By  reason  of  the  comparatively  small 
quantity  of  opium  contained  in  it,  it  is  not  well  adapted  for  cases  in 
which  powerful  opiates  are  indicated;  but  it  is  greatly  used  where 
gentle  opiates  are  required  — as  to  allay  cough,  and  to  procure  sleep 
in  children.  Rather  less  than  half  a grain  is  contained  in  half  a 
fluidoLince  of  the  tincture.  The  ordinary  dose  for  an  adult  is  a fluid- 
drachm,  or  an  ordinary  tea-spoonful. 

YINUM  O'PJl,  WINE  OF  O'PIUM,  ( OpHj  pulv.  ^ij;  Cinnam.  contus.;  Cary- 
ophyll.  contus.  aa  ^j.;  Vini^  Oj.)  This  is  the  Laudanum  of  Syden- 
ham., in  contradistinction  to  the  Laudanum  or  Liquid  Laudanum  p\s\. 
described.  Wine  dissolves  the  active  properties  of  opium,  and  the 
aromatics  may  adapt  it  for  cases  in  which  the  Tinctura  opii  disa- 
grees. It  is  not  much  used,  however,  internally.  It  has  been 
dropped  on  the  conjunctiva  in  turgid  states  of  the  vessels  of  that 
membrane,  and  with  decisive  advantage,  especially  where  there  has 
been  great  sensibility.  The  dose  of  the  wine  for  internal  adminis- 
tration is  the  same  as  that  of  the  Tinctura  opii. 

ACE  TUM  OTII,  VIN  EGAR  OF  O PIUM,  BLACK  DROP^  ( Opii,  in  p_ulv.  crass. 
5viij  ; Myrist.  in  pulv.  crass,  jiss  ; Croci,  ^ss;  Sacchar.  gxij  ; Acet. 
destillat.  q.  s.  The  opium,  nutmeg  and  saffron  are  digested  in  a 
pint  and  a half  of  distilled  water  for  forty-eight  hours,  and  strained. 
The  residue  is  digested  in  an  equal  quantity  of  distilled  vinegar  for 
twenty-four  hours.  The  whole  is  then  passed  and  repassed  by  dis- 


MORPHIA. 


355 


placement,  until  it  comes  away  quite  clear ; and  distilled  vinegar, 
enough  to  make  the  whole  three  pints,  is  passed  through  likewise. 
The  sugar  is  then  added,  and  the  whole  evaporated  to  three  pints 
and  four  fluid  ounces.) 

This  is  essentially  a solution  of  the  principles  of  opium  in  vinegar, 
rendered  slightly  excitant  by  the  nutmeg,  and  merely  coloured  by 
saffron.  It  is  the  officinal  black  drop^  and  is  intended  as  a substitute 
for  the  celebrated  empirical  medicine,  — called  by  the  same  name, 
and  sometimes  the  Lancaster  or  Quaker"' s Black  Drop.  It  is  adapted 
for  many  cases  in  which  opium  produces  its  disagreeable  effects,  and 
is  a very  favourite  article  with  many  practitioners.  It  is  stronger 
than  the  tincture  of  opium,  the  ordinary  dose  being  from  vj  to  xxx 
drops. 

EWPMS'TRUM  O'PII,  O'PIUM  PLASTER.  {Opii,  in  pu_lv.  gij  ; Bids  abietis, 
^iij  ; Emplast.  pluinbi^  ibj  ; Jiquce  bullientis^  f.  §iv.  The  lead  plas- 
ter and  Burgundy  pitch  are  melted  together;  the  opium,  previously 
mixed  with  the  water,  is  added,  and  the  whole  boiled  over  a gentle 
fire  to  the  proper  consistence.) 

This  plaster  is  employed  to  relieve  neuralgic  and  other  pains,  by 
being  applied  immediately  over  their  seat. 

Opium  forms  part  of  the  Pulvis  ipecacuanhas  et  opii  of  the  Pharma- 
copoeia of  the  United  States. 

MORPHIA. 

In  the  London  Pharmacopoeia,  morphia  is  directed  to  be  precipi- 
tated by  the  addition  of  solution  of  ammonia  to  chlorohydrate  or  mu- 
riate of  morphia.^  which  lays  hold  of  the  chlorohydric  acid,  and  sepa- 
rates the  morphia.  In  the  Pharmacopoeia  of  the  United  States, 
morphia  is  separated  from  opium  by  successive  macerations  in  dis- 
tilled water  until  the  salt  of  morphia  is  extracted.  The  fluid  of  the 
macerations  is  then  mixed  and  filtered  ; and  alcohol  and  solution  of 
ammonia  are  added,  by  which  the  meconate  or  other  salt  of  morphia 
is  decomposed  ; — the  alcohol  dissolving  the  colouring  matter  as  soon 
as  it  is  separated  by  the  ammonia  ; and  the  morphia  itself  being,  con- 
sequently, precipitated  in  a purer  state. 

The  crystals  of  morphia  are  colourless,  and  wholly  inodorous. 
They  are  scarcely  soluble  in  cold  water,  and  very  slightly  so  in  boil- 
ing water,  but  are  readily  dissolved  by  boiling  alcohol.  They  have  an 
alkaline  reaction,  and  their  primary  form  is  the  right  rhombic  prism. 
Morphia  dissolves  readily  in  dilute  acids,  neutralises  them,  and  forms 
salts,  which  are  for  the  most  part  soluble,  permanent  and  crystallisable, 
and  are  used  in  medicine. 

On  account  of  its  very  sparing  solubility  in  water,  it  is  but  seldom 
prescribed,  although  it  has  been  affirmed  by  one  observer,  M.  Bally, 
that  it  is  equally  efficacious  with  any  of  its  salts.  As  this,  however, 
is  probably  owing  to  the  presence  of  acid  in  the  stomach,  and  the 
amount  of  acid  varies,  the  salts  of  morphia  generally,  if  not  always, 


356 


SPECIAL  NARCOTICS. 


at  the  present  day,  receive  the  preference.  The  dose  is  one  sixteenth 
to  one-fourth  of  a grain. 

1.  MOR'PIUiE  ACE'TAS.  — AC'TTATE  OF  MORPHIA. 

The  acetate  of  morphia  is  made  by  mixing  morphia  in  powder, 
freed  from  narcotin  by  boiling  in  sulphuric  ether,  with  distilled  water ^ 
and  then  carefully  adding  acetic  acid,  until  the  morphia  is  saturated 
and  dissolved.  The  solution  is  then  evaporated,  and  the  acetate 
dried  with  u gentle  heat,  and  rubbed  into  powder. 

Acetate  of  morphia,  obtained  in  this  way,  is  amorphous  ; and  not 
wholly  soluble  in  water,  in  consequence  of  its  containing  a portion 
of  free  morphia,  which,  however,  is  rendered  soluble  by  the  addition 
of  a few  drops  of  acetic  acid.  It  is  less  soluble  in  alcohol  than  in 
water. 

The  salts  of  morphia  may  be  administered  advantageously,  not  only 
in  cases  where  opium  is  indicated,  but  where  it  disagrees.  With 
many  persons,  and  in  many  cases,  they  possess  decided  advantages 
over  opium,  but  the  author  has  pretty  generally  found,  that  where 
opium  disagreed,  morphia  and  its  preparations  did  so  likewise. 

By  one  method  of  exhibition  — the  endermic  — the  salts  of  mor- 
phia can  be  used  where  opium  and  its  preparations  cannot.  This 
method  is  adopted,  when  opium  or  the  salts  of  morphia  cannot  be 
borne  internally  ; and  where  a blister  has  been  directed  in  neuralgic 
and  other  cases,  it  is  not  uncommon  to  direct  the  denuded  surface  to 
be  sprinkled  or  dressed  with  a salt  of  morphia.  A quarter  of  a grain 
or  more  is  placed  upon  the  cutis  vera,  and  this  is  repeated  should  the 
case  require  it.  In  the  severer  neuralgic  and  neurotic  cases,  the 
quantity  applied  in  this  way  is  sometimes  very  large.  In  a case  of 
hydrophobia  reported  by  a recent  observer.  Dr.  Burne,  ten  grains  at 
a time  were  sprinkled  on  a blistered  surface  with  excellent  tranquilis- 
ing  effects.  Occasionally,  when  applied  to  a blistered  surface,  for 
several  days  in  succession,  a papular  eruption  is  observed,  which 
has  quickly  become  vesicular,  proceeding  from  the  edges  of  the 
blister,  and  gradually  spreading  over  the  entire  surface.  It  has  been 
proposed  to  inoculate  with  the  salts  of  morphia,  which,  when  thus 
used  — the  point  of  a lancet  being  dipped  in  an  aqueous  solution  of 
the  salt — give  occasion  to  the  formation  of  a papula  surrounded  by 
an  areola  and  accompanied  by  itching,  which  is  at  its  height  in  about 
an  hour.  In  one  case,  — in  which  thirteen  punctures  were  made  on 
the  anterior  part  of  the  forearm,  — the  patient  experienced  heaviness 
of  the  head,  frequent  yawning,  clamminess  of  mouth,  and  an  invinci- 
ble desire  to  sleep  ; yet  the  quantity  of  the  salt  of  morphia  used  could 
not  have  been  more  than  a quarter  of  a grain.  It  has  been  suggested, 
that  inoculation  with  morphia  may  supersede  the  use  of  blisters  and 
ammoniacal  plasters.  The  acetate  has  also  been  given  in  injection  in 
cases  of  chronic  diarrhoea,  and  has  been  made  into  an  ointment  to  be 
rubbed  over  pained  parts,  or  applied  immediately  to  them,  where 


MORPHIiE  SULPHAS. 


357 


this  is  practicable.  In  the  dose  of  a fourth  of  a grain  every  half  hour 
it  was  found  by  one  practitioner,  M.  Gerard,  to  be  preferable  to  every 
other  remedy.  He  continued  it  until  the  serious  symptoms  — the 
spasms,  diarrhoea  and  vomiting — had  ceased,  or  reaction  ensued. 

The  ordinary  dose  of  acetate  of  morphia  is  from  an  eighth  to  a 
quarter  of  a grain,  repeated  so  as  to  induce  the  anodyne  or  hypnotic 
edect.  As  in  the  case  of  opium,  under  excessive  pain,  or  long  con- 
tinued use,  the  system  may  be  so  habituated  to  its  action  as  to  bear 
very  large  doses.  A case  has  been  published  in  which  a female, 
under  a painful  affection,  took  scruple,  and  — according  to  her  own 
report  — half-drachm  doses  of  the  acetate. 

t MOR'PIIITl  MU'RIAS.  — MU  RIATE  OF  MOR'PHIA. 

Muriate  of  morphia  of  the  Pharmacopoeia  of  the  United  States 
is  made  by  mixing  morphia^  in  powder,  with  distilled  loater^  and 
carefully  adding  muriatic  acid  till  the  morphia  is  saturated  and  dis- 
solved. The  solution  is  then  evaporated  until  crystals  form  upon 
cooling.  These  crystals  are  of  a snow-white,  feathery  appearance, 
and  wholly  soluble  in  water.  They  are  devoid  of  smell,  and  of  a 
bitter  taste. 

This  salt  of  morphia  is  but  little  used  in  this  country,  but  is  more 
prescribed  than  either  of  the  others  in  Great  Britain.  There  are 
some,  indeed,  here,  who  prefer  it  to  the  sulphate,  which  is  most 
frequently  given  with  us  ; but  it  is  probable  that  more  accurate  ob- 
servation will  show,  that  they  are  capable  of  being  substituted,  in  all 
cases,  for  each  other. 

The  dose  of  the  muriate  is  the  same  as  that  of  the  acetate. 

I MORTHITl  SULPHAS.  — SULPHATE  OF  MOR'PHIA. 

Sulphate  of  morphia  is  formed  in  the  same  manner  as  the  muriate 
— diluted  sulphuric  acid  being  substituted  for  muriatic  acid.  It  is 
in  snow-white  feathery  crystals,  which  are  wholly  soluble  in  water. 
The  dose  is  the  same  as  that  of  the  acetate. 

LKIUOR  MOR'PHIAS  SULPHA'TIS,  Solution  of  Sulphate  of  Mor'phia. 
[MorphicB  sulphat.  gr.  viii ; Aquae  destillat.  Oss.)  This  solution  un- 
dergoes change  by  keeping,  and  admits  of  minute  quantities  of  the 
sulphate  being  administered.  A fluidrachm,  or  about  a tea-spoon- 
ful, contains  one  eighth  of  ^ grain. 

A combination  of  nitric  acid  with  opium,  forming  a nitrate  of 
MORPHIA,  is  the  basis  of  a mixture  attributed  to  Dr.  Baillie  of  Lon- 
don, and  of  one  which  has  been  much  used  in  this  country  in  dy- 
sentery and  chronic  diarrhcea,  under  the  name  of  Hopeh  Mixture^  so 
called  from  its  proposer.  It  is  made  as  follows  : — Acid,  nitros. 
seu  nitric,  f.  ^j.  Aquae  camphor,  f.  5^iij  ; Tinct.  opii^  gt.  xl.  Dose 
a fourth  part  every  three  or  four  hours. 

Many  years  a^o,  a Liquor  MoR'PHiiE  Citra'tis  was  directed  to 


358 


SPECIAL  NARCOTICS. 


be  prepared  in  the  following  manner.  Beat  four  ounces  of  the 
best  crude  opium  in  a mortar  with  two  ounces  of  crystallised  citric 
acid  ; mix  well  with  a pint  of  boiling  water ^ and  filter  after  24  hours’ 
maceration.  This  was  proposed  by  Dr.  Porter,  of  England,  and  is 
spoken  well  of  by  Dr.  Paris.  Megendie  recommends  a citrate  to  be 
formed  more  immediately,  according  to  the  following  formula. 
Morphice  pur.  gr.  xvi ; Acid,  citric,  crystallis.  gr.  viii ; Aquae  destillat. 
5j  ; Tinct.  cocci  q.  s.  ut  fiat  solutio.  The  dose  is  20  to  24  drops 
in  the  24  hours. 

A Tartrate  of  Morphia  was  suggested  by  the  author’s  friend? 
Mr.  C.  T.  Haden,  as  a substitute  for  the  liquor  opii  sedativus  of 
Mr.  Battley,  — a nostrum.  Mr.  Haden  prepared  it  by  macerating  the 
dregs  remaining  after  making  tincture  of  opium  in  a solution  of 
tartaric  acid.  Forty  drops  acted  in  every  respect  like  twenty  of 
the  liquor  opii  sedativus.  It  neither  excited  or  induced  costive- 
ness. 

A Bimec'onate  of  Mor^phia  has  been  introduced  by  Mr.  Squire,  of 
London,  and  has  been  highly  spoken  of  as  an  anodyne  and  hypno- 
tic ; but  the  formula  for  its  preparation  has  not  been  given  to  the 
profession.  The  same  may  be  said  of  a preparation  termed 
McMunn'^s  Elixir  of  Opium. 

2.  PAPA'VER.  — POP'PYHEADS. 

Papa'ver  somnif'erum,  Somniferous  or  White  Poppy  ; Sex.  Syst. 
Polyandria  Monogynia  ; Nat.  Orb.  Papaveracese,  is  indigenous  in 
Asia  and  Egypt,  and  grows  wild  in  some  parts  of  England,  having 
probably  escaped  from  gardens.  (Pereira.)  It  is  cultivated  in  orien- 
tal countries  for  the  sake  of  opium,  and  in  Europe  for  its  heads  or 
capsules,  as  well  as  for  the  oil  contained  in  the  seeds,  which  is  used 
in  the  arts.  The  heads  are  obtained  generally  from  the  white 
variety,  being  the  largest,  and  they  are  directed  by  the  Edinburgh 
college  to  be  gathered  before  they  are  wholly  ripe,  because  at  that 
time  they  abound  in  the  milky  juice  of  which  opium  is  made  ; 
whilst,  if  allowed  to  ripen  before  they  are  plucked,  as  directed 
by  the  London  and  Dublin  colleges,  the  juice  is  in  a great  measure 
exhausted. 

The  heads  — as  met  with  in  the  shops  — vary  in  size  from  that  of 
a hen’s  egg  to  that  of  the  fist,  are  of  a dirty  white  or  purplish- 
brown  colour,  of  a papyraceous  texture,  devoid  of  smell,  and  have 
a slightly  bitter  taste.  When  subjected  to  analysis,  they  contain 
principles  similar  to  those  of  opium,  which  they  readily  impart  to 
water. 

The  preparations  of  poppyheads  are  exceedingly  variable  in 
strength,  partly  owing  to  their  being  gathered  at  different  stages 
of  their  growth,  and  partly,  also,  owing  to  differences  in  the  variety 
of  the  plant  used  ; and  they  are,  consequently,  but  rarely  prescribed 
internally.  They  have  been  thought,  by  some,  to  agree  where 


HYOSCYAMUS.  359 

opium  (lid  not,  but  this  is  questionable  ; and  they  are  not  adapted 
for  any  purposes  which  opium  does  not  better  subserve. 

The  decoction  is  much  used  in  Great  Britain  as  an  anodyne 
fomentation,  although  it  has  been  properly  questioned,  whether 
it  produce  any  effect,  which  would  not  equally  follow  the  use  of  a 
mucilaginous  decoction. 

3.  HYOSCY'AMUS.  — HENBANE. 

Hyoscy’amus  niger,  or  Common  Henbane ; Sex.  Syst.  Pentandria 
Monogynia  ; Nat.  Ord.  Solanacese  ; is  indigenous  in  many  parts  of 
Europe,  and  is 
cultivated  for  me- 
dicinal purposes. 

It  has,  also,  been 
introduced  into 
this  country,  in 
the  northern  and 
eastern  parts  of 
which  it  is  found 
in  the  vicinity  of 
the  older  settle- 
ments. It  flowers 
in  July.  The 
leaves  — Hyos- 
cy'ami  Fo'lia, 
and  the  seeds 
Hyoscy'ami  Se- 
men — are  offici- 
nal in  the  Phar- 
macopoeia of  the 
United  States.  It 
is  generally  re- 
commended that 
the  plant  should 
be  gathered  when 
in  flower ; but  it 
has  been  found 
sufficiently  active 
even  in  the  spring 
The  wild  plant,  as  in  the  case  of  other  narcotics,  has  been  esteemed 
preferable  to  the  cultivated,  but  Dr.  Christison  affirms,  that,  from 
experiments  made  at  the  Royal  Infirmary  of  Edinburgh,  the  infe- 
riority of  cultivated  plants,  if  it  exist  at  all,  seems  not  to  be  appre- 
ciable in  practice.  The  plant  is  said  to  be  only  fit  for  medicinal 
use  in  the  second  year.  The  fresh  herb  has  a disagreeable  virous 
smell,  and  a mucilaginous  slightly  acrid  taste.  The  leaves  should 
be  dried  at  a temperature  not  exceeding  120°  Fahr.,  by  which  pro- 
cess 100  lbs.  of  the  fresh  herb  are  said  to  lose  86  per  cent.  When 


Fig.  51. 


Hyoscyamus  niger. 

before  the  appearance  of  the  flowering  stem. 


360 


SPECIAL  NARCOTICS. 


dried,  they  ought  to  preserve,  in  some  measure,  their  odour.  The 
seeds  have  the  smell  of  the  plant,  and  a bitter  taste. 

Both  the  seeds  and  extract  have  been  analysed,  and  found  to  con- 
tain a vegetable  alkali,  almost  identical  with  atropia,  to  which  the 
name  Hyoscyam’ia  or  Hyoscyami'na  has  been  given.  An  empyreu- 
matic  oil  of  henbane,  whose  properties  resemble  those  of  the  empy- 
reumatic  oil  of  foxglove,  was  obtained  by  destructive  distillation, 
which  proved  to  be  a powerful  narcotic  poison. 

‘ In  large  doses,  hyoscyamus  is  an  acro-narcotic  poison,  occasion- 
ing at  times  — but  not  so  often  as  belladonna,  and  stramonium, — 
nausea  and  vomiting,  purging,  disturbance  of  vision,  dilatation  of 
the  pupil,  coma,  and  often  delirium,  followed  by  death.  In  medi- 
cinal doses,  it  exerts  a soothing  influence  over  the  nervous  system, 
without  that  manifest  precursory  excitement  which  is  produced  by 
many  of  the  articles  of  the  class.  In  larger  doses  still,  it  acts  as  an 
hypnotic  ; at  least  such  is  the  general  belief.  It  must  be  admitted, 
however,  that  it  frequently  fails  ; and  it  is  affirmed  to  induce  deli- 
rium rather  more  frequently  when  pushed  to  a great  extent.  It  cer- 
tainly is  not  at  all  comparable  to  opium  as  an  anodyne  and  hypno- 
tic ; yet  there  are  cases  in  which  opium  and  its  preparations  disa- 
gree, and  in  which  henbane  may  be  prescribed  as  a substitute.  For 
example,  opium,  even  in  small  doses,  occasions,  in  particular  per* 
sons,  violent  cephalalgia,  nausea  and  vomiting,  and  is  apt  to  induce 
constipation  ; none  of  which  phenomena  follow  the  use  of  hyoscya- 
mus. It  is  not,  however,  extensively  employed ; for  whilst  one  re- 
spectable writer.  Dr.  Wood,  remarks,  that  it  is^‘at  present  used 
almost  exclusively  to  relieve  pain,  procure  sleep,  or  quiet  irregular 
nervous  action,”  another.  Dr.  Christison,  states,  that  ‘‘  probably  the 
chief  consumption  of  it  now-a-days  is  in  combination  with  those 
purgatives  which  cause  griping,  and  more  especially  with  the  com- 
pound colocynth  pill-mass.” 

It  is  unnecessary  to  enumerate  the  cases  in  which  hyoscyamus  is 
given  internally.  It  would  be  but  repeating  what  is  said  under  the 
various  narcotics.  Wherever  an  anodyne,  hypnotic,  or  antispas- 
modic  is  needed,  it  is  prescribed  ; and,  as  already  shown,  there 
may  be  cases  in  which  it  may  be  used  when  opium  cannot  be  ; al- 
though whenever  the  latter  can  be  borne,  it  is  infinitely  preferable. 
Like  belladonna,  it  may  be  used  to  dilate  the  pupil,  but  it  is  not  so 
energetic  ; and  like  it,  it  has  been  employed  in  the  way  of  injec- 
tion, and  as  a fomentation  in  painful  tumefactions  and  ulcerations. 

The  dose  of  the  powdered  leaves  — which,  however,  are  rarely 
prescribed  — is  from  gr.  v.  to  gr.  x. 

EXTRAC'TUM  HYOSCY'AMI,  EXTRACT  OF  HENBANE,  is  the  inspissated  juice 
of  the  leaves,  112  lbs.  of  the  fresh  plant  yield  from  4 to  5 lbs., 
according  to  one  experimenter,  Mr.  Brande;  according  to  another, 
Mr.  Squire,  fbv.  ^ix.  That  used  in  this  country  is  chiefly  obtain- 
ed from  Great  Britain,  and  is  very  variable  in  its  quality.  It  is  the 


BELLADONNA. 


361 


preparation  of  henbane,  which  is  most  commonly  prescribed,  — be- 
ing given  internally  in  the  dose  of  gr.  v to  gr.  x,  or  more.  It  is  a 
common  adjunct  to  the  compound  extract  of  colocynth,  and  to  aloes, 
whose  irritating  qualities  it  obviates ; so  that  in  pregnancy,  pills  of 
aloes  and  hyoscyamus  may  be  taken  with  safety.  Like  other  nar- 
cotic extracts,  it  may  be  added  to  topical  applications  to  tender 
parts — as  to  hemorrhoids;  and  it  is  occasionally  formed  into  a 
plaster,  which  is  used  in  neuralgic  pains,  glandular  and  scirrhous 
swellings,  &c. 

An  ALCOHOL  IC  EXTRACT  OF  HYOSCY'AMS  — EXTRAC'TUM  HYOSCYAMI  ALCO- 
HOL'ICUM,  has  been  introduced  into  the  last  edition  of  the  Pharmaco- 
poeia of  the  United  States  (1842).  It  is  made  from  the  leaves,  in 
coarse  powder.  The  dose  is  about  the  same  as  that  of  the  simple 
extract,  than  which  it  has  been  regarded  as  more  certain. 

TINCTU'RA  HYOSCY'AMI,  TINCTURE  OF  HENBANE.  {Hyoscyam.  foL  Jiv; 
cohol.  dilut.  Oij ; prepared  either  by  simple  maceration  or  by  dis- 
placement.) The  dose  as  an  hypnotic  is  f.  to  f.  gij.  Should  it 
act  on  the  bowels,  it  has  been  suggested,  that  a very  small  quantity 
of  the  tincture  of  opium  should  be  added  to  it,  which  may  be  done 
in  cases  where  opium  does  not  disagree. 

4.  BELLADON^NA. 

Belladonna  is  the  officinal  name,  in  the  United  States  Pharmaco- 
poeia, for  the  leaves  of  A'tropa  Belladon'na^  Common  Dwale,  Deadly 
JVightshade ; Sex.  Syst.  Pentandria  Monogynia ; Nat.  Ord.  So- 
lanacese,  a plant,  which  is  a native  of  Europe,  growing  in'  hedges 
and  waste  ground  on  a calcareous  soil ; flowering  in  .June  and  July, 
and  ripening  its  fruit  in  September.  The  leaves  are  usually  collected 
before  the  flowers  bloom  or  soon  afterwards.  The  root,  also,  is  offi- 
cinal in  the  Dublin  Pharmacopoeia.  The  dried  leaves  are  of  a dull 
greenish  colour,  with  a feeble  narcotic  smell,  and  a subacrid  and 
slightly  nauseous  taste.  They  impart  their  virtues  to  both  water 
and  alcohol. 

On  analysis,  belladonna  yields  a vegetable  alkaloid  — Atrop'ia  — 
on  which  the  narcotic  properties  appear  to  be  dependent,  and  which 
may  be  obtained  by  a process  similar  to  that  for  procuring  aconitia 
from  aconite.  This  principle  has  not  been  admitted  into  the  Phar- 
macopoeias. It  is  a most  virulent  poison  — a tenth  of  a grain  caus- 
ing, in  the  human  subject,  dryness  of  the  mouth,  constriction  of  the 
throat,  difficulty  of  deglutition,  headache,  dilatation  of  the  pupil,  and 
stupor. 

Belladonna  is  a powerful  narcotic  poison  in  large  doses.  To  a 
less  extent  it  possesses  the  ordinary  properties  of  the  narcotics,  along 
with  some  that  are  peculiar  to  itself.  When  carried  to  such  an  ex- 
tent as  to  affiect  the  system,  it  induces  dryness  of  the  mouth  and  throat, 
vertigo,  dilatation  of  the  pupils,  dimness  of  sight;  when  to  a greater 
VOL.  I. — 31 


362 


SPECIAL  NARCOTICS. 


extent,  delirium,  and  — it  is  affirmed — an  eruption  closely  resem- 
bling that  of  scarlatina.  To  this,  reference  will  be  made  presently. 

The  first  set  of  symptoms  were  induced  on  the  author  by  tasting 
some  newly  prepared  extract  of  belladonna  prepared  by  himself.  The 
dilatation  of  the  pupil  continued  for  a fortnight,  becoming  gradually 
less  and  less,  but  impairing  vision  whilst  it  persisted.  These  effects 
show,  that  the  main  effect  of  belladonna  is  exerted  upon  the  or- 
gans of  innervation  : those  of  secretion  become  modified  subse- 
quently. 

Belladonna  is  administered  in  many  diseases  for  the  purpose  of  al- 
laying pain,  or  diminishing  the  impressibility  of  the  nervous  centres 
or  of  the  nervous  cords.  In  this  respect,  it  is,  as  a general  rule,  far 
inferior  to  opium,  yet  there  are  some  diseases  in  which  it  occasion- 
ally succeeds  after  opium  has  failed  ; for  example,  in  the  various 
forms  of  neuralgia,  in  which  it  is  often  necessary  to  push  the  reme- 
dy, until  some  of  the  effects  above  mentioned  are  induced.  Ad- 
ministered in  this  manner,  — like  the  other  narcotics,  it  has  been  pre- 
scribed in  rheumatism. 

In  diseases  characterised  by  great  nervous  impressibility,  as 
hooping-cough,  it  has  occasionally  afforded  relief : but  it  can  only  be 
regarded  as  a palliative  in  that  singular  self-limited  disease.  A mo- 
dern writer.  Dr.  A.  T.  Thomson,  affords,  however,  the  following  strong 
testimony  in  its  favour  : — ‘‘I  have  ordered  the  extract  in  doses  of 
one-eighth  of  a grain  to  a child  of  eight  years  of  age,  and  gradually 
increased  the  dose  to  a quarter  of  a grain.  Its  power  over  the  cough 
is  extraordinary.  It  produces  a state  of  the  skin  closely  resembling 
scarlatina,  accompanied  with  fever,  suffused  eye,  dimness  of  sight, 
and  frequently,  although  not  always,  headache.  Whilst  these  symp- 
toms continue,  the  cough  remains  absent,  but  it  returns  as  soon  as 
they  disappear.  By  keeping  the  habit  for  a sufficient  time  under 
the  influence  of  the  remedy,  the  period  of  the  disease  has  always 
been  greatly  shortened.” 

Belladonna  has  also  been  prescribed  in  epilepsy,  mania,  hysteria, 
chorea,  and  in  the  neuroses  in  general ; but  no  marked  effect  has  re- 
sulted, except  what  would  probably  have  equally  resulted  from  the 
employment  of  opium  or  some  of  its  preparations. 

Dr.  Graves  has  ingeniously  suggested  the  use  of  belladonna  in 
cases  of  fever  accompanied  with  contraction  of  the  pupil,  under  the 
view,  that  the  state  of  the  brain,  which  accompanies  dilatation  of  the 
pupil,  is  different  from  that  which  accompanies  contraction ; and 
hence,  as  belladonna  occasions  dilatation  of  the  pupil,  its  adminis- 
tration may  do  much  towards  counteracting  the  condition  of  the  en- 
cephalon that  occasions  the  opposite  condition  of  the  pupil.  Were 
this  view,  however,  correct,  it  would  seem  equally  probable,  that  as 
aconite  produces  contraction  of  the  pupil,  it  ought  to  be  a remedy 
for  encephalic  conditions  that  are  accompanied  by  dilatation  of  the 
pupil  ; and  farther,  that  aconite  ought  to  be  capable  of  counteracting 
the  dilatation  of  the  pupil  occasioned  by  belladonna.  These  woulu 
be  strange  results  if  they  really  occurred. 


BELLADONNA. 


363 


The  property  possessed  by  belladonna  of  dilating  the  pupil  adapts 
it  for  the  treatment  of  certain  diseases  of  the  organ  of  vision.  It  is 
largely  used  by  the  surgeons  of  Europe,  both  for  the  purpose  of  ex- 
ploration and  treatment.  In  cases  of  cataract,  for  example,  it  enables 
the  surgeon  to  appreciate  its  extent;  and, in  obscure  diseases,  to  in- 
spect the  depth  of  the  eyeball.  In  the  operation  for  cataract,  it  allows 
of  the  lens  passing  out  more  readily.  In  iritis,  it  prevents  adhesions 
between  the  posterior  part  of  the  iris  and  the  anterior  part  of  the  cap- 
sule of  the  crystalline,  or  ruptures  them  when  fresh.  It  is  occasion- 
ally, also,  used  in  inflammatory  and  other  affections  of  the  eye,  to 
diminsh  the  sensibility  of  the  organ  to  light. 

For  producing  dilatation  of  the  iris,  a little  of  the  extract  may  be 
rubbed  with  the  wet  finger  round  the  eyelids,  or  a solution  be  dropped 
into  the  eye.  In  a few  hours,  the  pupil  generally  becomes  largely 
dilated,  so  much  so,  that,  the  iris  appears,  at  times,  as  if  it  were  totally 
gone.  This  condition  generally  continues  for  a few  days. 

Owing  to  its  effect  upon  the  iris,  its  use  has  been  suggested  in  la- 
bour accompanied  with  unusual  rigidity  of  the  os  uteri.  With  this 
view,  either  the  soft  extract,  or  an  ointment  composed  of  Extract  of 
Belladonna  5j — 3ij  ; Spermaceti  Ointment  or  Lard  ^i,  may  be  rub- 
bed upon  the  os  uteri.  It  is  not,  however,  much  employed.  In  spas- 
modic and  neuralgic  affections  of  the  urethra,  bladder,  rectum,  and 
vagina,  belladonna  has  likewise  been  used,  either  applied  to  a bougie, 
or  passed  into  the  rectum,  in  the  form  of  injection  or  suppository. 

In  all  cases,  it  is  important  that  there  should  be  no  abrasion — as 
the  belladonna  might  produce  an  undesirable  narcotic  impression 
upon  the  system. 

In  certain  painful  affections  of  the  chest,  and  in  painful  scirrhous 
and  glandular  enlargements,  a belladonna  plaster  is  not  unfrequently 
applied.  Its  narcotic  influence  may  be  partially  exerted  in  this  way; 
but  it  is  probably  but  little  adapted  for  the  removal  of  those  affections, 
as  was  at  one  time  believed. 

There  is  one  other  application  of  the  belladonna,  which  remains 
to  be  particularly  noticed — as  a preventive  of  scarlatina.  It  has 
already  been  remarked,  that  when  given  to  a certain  extent,  it  is 
apt  to  induce  a cutaneous  efflorescence  similar  to  that  of  scarlatina. 
This,  of  course,  suggested  to  the  homoeopathist  to  make  trials  of  the 
remedy  as  a prophylactic  against  that  often  formidable  disease.  In 
another  work,  [Practice  of  Medicine^  2d  edit.  ii.  537,  Philadelphia, 
1844,)  the  author  has  stated,  that  he  has  never  witnessed  the  erup- 
tion, nor  does  its  production  seem  to  be  considered  necessary  where 
the  belladonna  has  been  given  as  a prophylactic.  The  testimony, 
for  and  against  its  preventive  powers  in  scarlatina,  has  been  consi- 
derable. It  is  easy  to  see,  however,  that  inasmuch  as  all  are  not  at- 
tacked, who  are  exposed  to  a disease  which  is  unquestionably  con- 
tagious, any  article,  exhibited  with  the  view  of  prevention,  may  rea- 
dily gain  credit  for  the  possession  of  such  powers  without  meriting 
it.  Still  more  easy  is  it,  in  the  case  of  a disease  like  scarlatina, 
which  many  consider  spreads  by  epidemic  rather  than  by  contagious 


364 


SPECIAL  NARCOTICS. 


influences.  The  belladonna  certainly  has  often  failed,  and  a striking 
case  of  the  kind  is  given  by  a recent  respectable  writer — Dr.  Sigmond 
— of  a family  of  eleven  persons,  who  took  it,  yet  every  one  of  them 
was  attacked.  Hahnemann’s  direction  for  exhibiting  it  in  such 
cases  is  to  dissolve  three  grains  of  the  extract  in  a fluidounce  of  cin- 
namon water ^ and  to  administer  three  drops  of  this  solution,  twice  a 
day,  to  a child  a year  old,  adding  one  drop  for  every  year,  until 
twelve  drops  are  taken  for  a dose  ; this  course  to  be  adopted  at  the 
commencement  of  the  epidemic,  and  to  be  persevered  in  whilst  it 
rages. 

The  dose  of  the  powdered  leaves  of  Belladonna  is  one  grain, 
which  may  be  gradually  increased  until  its  peculiar  effects  — dry- 
ness of  the  mouth,  dilatation  of  the  pupil,  or  some  of  the  cephalic 
phenomena  supervene.  The  powder  is  rarely,  however,  given  in- 
ternally. The  fresh  leaves  are  sometimes  applied  warm  as  a fomen- 
tation to  pained  parts;  and,  occasionally,  an  infusion  is  used  for  a 
similar  purpose,  or  the  powder  is  made  to  form  part  of  a cataplasm. 

EXTRAC'TUM  BELLADON'NJ],  EXTRACT  OF  BELLABOX'NA,  This  extract  is 
made  from  the  expressed  juice  of  Belladonna.  It  is  the  preparation 
most  frequently  used.  The  dose  may  be  a quarter,  or  half  a grain, 
repeated  three  times  a day,  and  gradually  increased  until  the  con- 
stitutional effects  of  the  remedy  appear.  It  has,  however,  been 
given  in  much  larger  quantities.  Its  topical  uses  have  already  been 
referred  to  ; but  it  may  be  added,  that  a decoction  of  the  extract  or 
of  the  leaves  has  been  recommended,  like  other  narcotics,  as  an  in- 
halation in  spasmodic  asthma. 

An  ALCOHOLIC  EXTRACT  OF  BELLADONNA— EXTRAC'TUM  BELLABOFNE  ALCO- 
IIOL'ICUM — has  been  introduced  into  the  last  edition  of  the  Pharma- 
copoeia of  the  United  States  (1842.)  It  is  prepared  by  the  action  of. 
diluted  alcohol^  by  displacement,  on  Belladonna  in  coarse  powder. 
The  fresh  leaves  are  not  always  attainable,  and  this  formula  fur- 
nishes a method  for  obtaining  the  extract  in  their  absence. 

TINCTU'RA  BELLADON'NJl,  TINCTURE  OF  BELLADONNA. 1\y]J11co- 
hol.  dilut.  Oij  ; prepared  by  maceration  or  displacement.)  The  dose 
of  the  tincture  is  from  rr^xx  to  n\^xl,  watching  the  effects.  It  is  offi- 
cinal in  the  Pharmacopoeia  of  the  United  States,  not  in  those  of 
Great  Britain. 

EMPLASTRUM  BELLADON'NTl,  PLASTER  OF  BELLADON'NA.  {Emplastr.  Re- 
sin. §iij  ; Extract.  Belladonnce.,  §iss.)  This  plaster  is  used  as  an 
anodyne  and  revellent  in  neuralgic  pains,  and,  indeed,  in  most  pain- 
ful affections  that  are  deep  seated.  Dr.  Wood  states,  that  he  has 
seen  the  constitutional  effects  of  belladonna  result  from  its  applica- 
tion. Care  ought  to  be  taken  not  to  apply  it  to  an  abraded  surface. 

5.  STRAMO'NTUM. 

Datu'ra  Stramo'nium,  Thorn  Apple ^ or  Jamestown  Weed ; Sex, 


STRAMONIUM. 


365 


SvsT.  Pentandria  Monogynia ; Nat.  Ord.  Solanacese,  is  met  with 
in  various  parts  of 
Europe,  Asia,  and 
America  ; but  its  na- 
tive country  appears 
to  be  unknown.  In 
the  United  States,  it 
is  very  common  in 
the  vicinity  of  every 
inhabited  spot,  in 
waste  ground,  and 
on  dunghills.  It  flow- 
ers from  May  to  Au- 
gust, according  to  the 
temperature.  The 
leaves,  Stramo'nii 
FoTia  ; the  root, 

Stramo'nii  Radix  ; 
and  the  seeds,  Stra- 
mo'nii Semen,  are 
officinal  in  the  Phar- 
macopceia  of  the  Uni- 
ted States.  The  first 
are  gathered  when 
the  flowers  are  full 
blown,  at  which 
time  they  possess 
an  unpleasant  virous 
odour,  sufficient  to 
produce  a disagreeable  impression  on  the  olfactories,  when  the  plac^ 
is  approached  in  which  the  plant  grows.  Their  taste  is  bitter  and 
nauseous.  The  disagreeable  odour  is  lost  by  drying,  but  the  taste 
remains.  The  seeds  are  small,  compressed,  kidney  shaped,  and  of 
a brown,  almost  black,  colour,  without  smell,  but  having  the  bitter, 
nauseous  taste  of  the  leaves,  and  a somewhat  acrid  taste. 

All  parts  of  the  plant  yield  their  virtues  to  water,  alcohol,  and 
the  fixed  oils,  which  are  consequently  used  in  various  preparations. 
The  plant  has  been  analysed  by  different  chemists,  and  found  to 
contain  an  active  vegetable  alkali,  to  which  the  name  Datu'ria  or 
Daturi'na  has  been  given,  and  which  is  separated  in  the  same  man- 
ner as  hyoscyamia.  It  dilates  the  pupil,  and  is  highly  poisonous  to 
animals,  but  is  not  used  in  medicine.  By  destructive  distillation,  a 
poisonous  oil  is  obtained,  which  does  not  differ  in  its  physical  and 
chemical  properties  from  the  empyreumatic  oil  of  foxglove. 

Stramonium  is  a powerful  narcotic,  producing  effects  like  those  of 
belladonna,  when  taken  in  large  doses,  — as  dryness  of  the  throat, 
and  delirium,  followed  by  coma,  with  dilated  pupils,  and  at  times 
31* 


Fig.  52. 


Datura  Stramonium. 


3G6 


SPECIAL  NARCOTICS. 


convulsions.  In  medicinal  doses,  it  appears  to  resemble  hyoscyamus  ; 
to  be  anodyne,  and,  to  a certain  extent,  hypnotic  ; rather  tending  to 
relax  the  bowels  than  to  constipate,  and  agreeing  where  opium  can- 
not he  borne.  Still,  for  internal  use,  it  is  less  employed  than  the 
other  narcotics  already  considered,  although  it  may  be  used  in  the 
very  same  cases. 

In  spasmodic  asthma  — as  else’where  shown  — it  is  made  to  come 
in  contact  with  the  pneumogastric  nerves  by  inhalation,  with  marked 
advantage,  — the  benefit  resulting,  in  such  cases,  from  its  narcotic 
influence.  Like  the  other  narcotics  it  is  also  used  externally,  the 
leaves  being  applied  warm  to  painful  tumours,  irritable  ulcers,  &c. 
For  the  purpose  of  dilating  the  pupil,  as  well  as  of  diminishing  the 
sensibility  of  the  retina  to  the  influence  of  light,  belladonna  is  more 
used  in  Europe : in  this  country,  the  extract  of  stramonium  is  often 
employed.  The  dose  of  the  powdered  leaves  is  two  or  three  grains  ; 
that  of  the  seeds,  a grain,  repeated  until  the  constitutional  influence 
is  manifested,  or  until  some  effect  is  exhibited  on  the  morbid  phe- 
nomena. 

EXTRAC  TUM  STRAMO'NII  FOLIO 'RUM,  EXTRACT  OF  STRAMO'MM  lEAITS. 
This  is  the  inspissated  juice  evaporated. 

EXTRAC'TIJI  STRAMO'NII  SEM'INIS,  EXTRACT  OF  STRAMO  NIUM  SEED.  This 
is  obtained  from  stramonium  seed  by  the  process  of  displacement, 
through  the  action  of  dilute  alcohol.  It  \sX\ie  alcoholic  extract  of  the 
seed^  and  is  preferable  to  the  first.  The  dose  of  the  first  is  a grain  ; 
of  the  last  half  a grain,  gradually  increased.  When  applied  to  the 
eye  to  induce  dilatation  of  the  pupil,  in  the  same  cases  as  the  extract 
of  belladonna,  it  may  be  softened  and  gently  rubbed  over  the  eye- 
lid, or  a solution  may  be  dropped  into  the  eye. 

TINCTU'RA  STRAMO'NII,  TINCTURE  OF  STRAMO  NIUM.  (Stramon.  sem.  contus. 
giv  ; Alcohol,  dilut.  Oij.  Prepared  either  by  maceration  or  by  dis- 
placement.) The  dose  is  rt^^x  to  ti\^xx,  two  or  three  times  a day,  un- 
til some  effect  is  induced.  It  may  be  given  wherever  stramonium  is 
indicated. 

UNGUEN'TUM  STRAMO'NH,  OINTMENT  OF  STRAMO'NIUM.  {Stramon.  foL  re- 
cent,  concis.  tbj  ; Adipis^  ibiij  ; Cerce  flavcx.,  thss.  The  leaves  are 
boiled  in  the  lard  until  they  are  friable,  then  strained,  and  to  the  pro- 
duct, the  wax,  previously  melted,  is  added.)  This  ointment  is  used 
as  an  anodyne  application  to  painful  ulcers,  hemorrhoids,  &c.,  and 
is  a great  favourite  with  some  surgeons,  being  prescribed  in  cases 
wLere  others  would  use  nothing  more  than  simple  cerate. 

Atrop'ia,  Adropine  (see  page  361  of  this  volume,)  has  been  re- 
cently recommended  by  Mr.  W.  W.  Cooper,  Surgeon  to  the  North 
London  Ophthalmic  Institution,  as  a substitute  for  belladonna  for 
dilating  the  pupil  in  cases  of  cataract,  &c.  He  dissolves  two  grains 
in  a drachm  of  alcohol  to  seven  drachms  of  distilled  water.  A full 


CONIUM. 


367 


drop  of  this  solution,  placed  in  the  eye,  produces,  in  the  generality 
of  cases,  a speedy  and  complete  dilatation  of  the  pupil.  In  some  in- 
stances, however,  a stronger  solution  may  be  required.  Mr.  Cooper 
never  observed  any  ill  elfects  from  its  use,  although  he  has  tried  it 
in  the  proportion  of  four  grains  to  the  ounce.  He  directs  a drop  to 
be  used  night  and  morning  where  he  wishes  to  keep  up  the  dilata- 
tion of  the  pupil. 

6.  CONI'UM.— HEMLOCK. 

Both  the  leaves,  Coni'i  Fo'lia,  and  the  seed  or  fruit,  Coni'i  Semen, 
of  the  Coni' um  macu- 
lat'um,  are  officinal  in 
the  Pharmacopoeia  of 
the  United  States. 

The  plant,  called  also 
common  or  spotted 
hemlock ; Sex.  Syst. 

Pentandria  Digynia ; 

Nat.  Ord.  Umbelli- 
ferse,  is  indigenous  in 
Europe,  and  has  been 
naturalised  in  the  Uni- 
ted States,  and  also 
in  Chili,  growing  usu- 
ally in  waste  grounds, 
and  by  the  roadsides, 
especially  in  inhabited 
places.  It  flowers  in 
June  and  July,  and 
the  fruit  ripens  in 
August  and  Septem- 
ber. The  whole  plant 
has  an  exceedingly 
disagreeable  virous 
smell,  compared  by 
some  to  that  of  mice  ; 
by  others  to  that  of 
cantharides,  or  of  the 
urine  of  the  cat,  by 
which  it  may  be  distinguished  from  other  umbelliferous  plants.  Its 
proper  characteristics  are,  however,  botanical.  The  plant  is  consi- 
dered to  be  more  active  in  warm  countries,  and  in  hot  and  dry  sea- 
sons. The  leaves  are  generally  gathered  when  the  plant  is  in  full 
flower,  or  even  later,  when  the  fruit  is  forming.  Dr.  Christison, 
however,  affirms  as  the  result  of  his  experiments,  that  there  seems 
to  be  no  great  difference  in  its  poisonous  properties  at  any  season, 
as  even  in  November  and  March  of  its  first  year  its  activity  is  very 
great.  The  same  gentleman  remarks,  that,  contrary  to  the  opinion  of 


Fig.  53. 


368 


SPECIAL  NARCOTICS. 


Geiger,  the  seeds  have  always  appeared  to  him  to  be  considerably 
more  active  when  green  than  when  ripe  and  dry  : they  are  much 
more  active  than  the  leaves,  and  he  considers  this  an  objection  to 
the  adoption  of  the  seeds  by  the  London  College  as  an  article  of  the 
Materia  Medica,  and  the  remark  would  of  course  apply  equally  to 
the  Pharmacopceia  of  the  United  States — unless  they  were  used  for 
some  special  purpose  different  from  those  to  which  the  leaves  are  ap- 
plied. A great  advantage,  however,  of  the  seeds  would  seem  to  be, 
that  they  retain,  for  a much  longer  time  than  the  leaves,  their  active 
principle  unchanged. 

Hemlock  leaves,  when  dried  at  a temperature  not  higher  than  120° 
Fahr.,  and  with  exclusion  of  solar  light,  have  a fine  green  colour, 
and  the  characteristic  smell  of  the  plant.  They  should  be  preserved 
in  tin  canisters  well  closed.  It  would  seem,  however,  that  but  little 
reliance  can  be  placed  upon  the  dried  leaves,  as,  according  to  Dr. 
Pareira,  however  carefully  prepared,  they  sometimes  yield  none  of 
the  active  principle,  coma,  even  although  they  may  have  a fine 
green  colour,  and  the  hemlock  smell.  The  taste  is  nauseous,  but 
much  less  so  than  that  of  the  fresh  plant.  The  seeds  have  very 
little  odour,  and  a slight,  somewhat  bitter,  and  nauseous  taste. 

Conium  has  been  repeatedly  subjected  to  chemical  analysis,  but 
without  any  great  advantage  to  pharmacology.  One  of  the  most 
curious  results  was  obtained  by  Schrader,  who  found  the  analysis  of 
the  hemlock  and  cabbage  to  be  strikingly  analogous  ! When  sub- 
jected to  distillation,  a volatile  oil,  of  an  acrid  taste  and  of  the  pecu- 
liar odour  of  the  plant,  passes  over,  which  is  not,  however,  poison- 
ous ; hence,  the  smell  of  the  leaves  would  be  an  unsatisfactory  test  of 
their  activity.  When  triturated  with  a solution  of  potassa,  an  intense 
and  peculiar  odour  is  exhaled,  arising  from  the  disengagement  of  the 
active  principle  Coni' Con'ein^  Con'icin  or  Ci'cutin,  which  is  supposed 
to  be  present  in  combination  with  an  acid,  and  requires  the  agency 
of  an  alkali  to  disengage  it.  It  is  possessed  of  wonderful  activity  as 
a poison.  It  cannot  be  procured  from  the  dried  leaves ; but  may  be 
from  the  dried  fruit. 

Conium  is  one  of  the  narcotics  so  strongly  extolled  by  Storck  in 
cancerous  affections,  not  simply  with  the  view  of  its  narcotic  action, 
but  as  a modifier  of  the  system  of  nutrition,  or  a eutrophic.  At  the 
present  day,  however,  the  latter  action  has  been  more  properly  re- 
ferred to  the  therapeutical  agents  prescribed  with  it,  for  the  belief  of 
its  ‘ deobstruenC  operation  has  now  altogether  passed  away  in  the 
opinion  of  the  best  observers. 

In  regard  to  its  precise  operation  on  the  encephalo-spinal  system, 
and  the  phenomena  induced  by  it,  discordance  of  sentiment  exists,  — 
so  much  so,  that  a very  recent  writer.  Dr.  Christison,  expresses  the 
opinion,  ‘‘  that  the  entire  subject  of  the  medicinal  actions  and  uses 
of  hemlock  requires  to  be  investigated  anew  ; and  it  well  deserves 
investigation,  considering  its  singular  energy  and  peculiar  effects  as 
a poison.” 


CONIUM. 


369 


Cases  are  on  record,  in  which  the  leading  symptom  produced  by 
it  was  coma  : others  have  ascribed  convulsions  to  it.  On  the  other 
hand,  the  experiments  of  Dr.  Christison  led  him  to  infer,  that  it  does 
not  excite  convulsive  spasn's,  or  bring  on  insensibility  ; but  that  it 
exhausts  the  nervous  energy  of  the  spinal  chord  and  voluntary  mus- 
cles, occasioning  merely  convulsive  tremors  and  slight  twitches,  and 
eventually  general  paralysis  of  the  muscles,  and  consequent  stoppage 
of  the  breathing.  He  found,  however,  that  it  leaves  the  heart’s  ac- 
tion unimpaired,  and  does  not  prevent  the  blood  from  coagulating  — 
as  was  at  one  time  imagined  — any  more  than  other  causes  of  death 
by  asphyxia.  On  the  other  hand,  however,  Mr.  Judd  infers  from 
more  recent  experiments  with  medicinal  doses  on  cats  and  other 
animals,  that  the  well-made  extract  causes  great  languor  and  drowsi- 
ness, and  often  profound  sleep  for  two  or  three  hours,  lessens  mus- 
cular excitability,  and  reduces  the  circulation  as  well  as  the  animal 
heat.  He  is,  consequently,  induced  to  believe,  that  it  really  deserves 
the  reputation  it  has  enjoyed  with  many  of  being  an  efficient  ano- 
dyne and  hypnotic  ; he  adds,  that  on  some  trials  with  it  in  affections 
of  the  chest,  he  found  it  to  allay  cough  and  promote  sleep,  and  he 
considers  it  especially  applicable  to  the  treatment  of  hypertrophy  of 
the  heart,  phrenitis,  and  other  affections  attended  with  an  excited  or 
excitable  state  of  the  circulation. 

Recently,  Dr.  Pliny  Earle  has  instituted  some  experiments  upon 
himself  to  determine  the  physiological  effects  of  the  extract.  In  fifty 
grain  doses  it  caused  vertigo,  dimness  of  vision,  a feeling  of  mingled 
weariness,  and  weakness  in  the  knees  ; defective  firmness  in  the 
gait ; the  same  kind  of  feeling  in  the  lower  part  of  the  biceps  of  the 
arm  as  in  the  knees  ; with  a constant  disposition  to  bend  and  extend 
the  forearm.  The  pupils  were  apparently  dilated  ; but  it  did  not 
appear  to  induce  any  hypnotic  effect.  Dr.  Earle  states,  that  for 
several  years  he  has  been  accustomed  to  the  free  use  of  the  extract  of 
conium  in  the  treatment  of  insanity,  without  ever  having  produced 
sleep  by  it,  even  in  doses  gradually  raised  to  60,  80  and  90  grains, 
three  times  a day. 

The  author  has  given  the  remedy  a fair  trial  in  various  painful 
affections,  but  he  has  been  extremely  dissatisfied  with  it ; and  is  dis- 
posed to  think,  as  the  result  of  his  observations,  that  it  is  often  alto- 
gether inert.  It  is  used  internally  in  the  same  cases  as  the  narcotics 
already  described  ; and  fomentation  of  fresh  hemlock  leaves,  or  a 
poultice  of  the  extract  or  of  a decoction  of  the  leaves,  or  a hemlock 
ointment  o'[  plaster  is  not  unfrequently  prescribed  to  allay  the  pain  of 
malignant  ulcerations,  or  of  neuralgic  suffering. 

Like  some  of  the  other  remedies  of  the  class,  it  has  been  supposed 
to  possess  antaphrodisiac  virtues,  and  has,  consequently,  been  pre- 
scribed in  cases  in  which  there  was  over-excitement  of  the  venereal 
appetite.  It  has  also  been  supposed  to  possess  diuretic  properties.  In 
the  experiments  of  Dr.  Earle,  however,  there  was  no  perceptible  aug- 


370 


SPECIAL  NARCOTICS. 


mentation  or  diminution  of  the  urine.  On  two  occasions,  once  after 
taking  one  of  the  largest  doses  of  the  American,  and  once  after  one 
of  the  largest  doses  of  the  British  extract,  he  felt  an  acute,  lancinating, 
and  transient  pain  in  the  region  of  the  neck  of  the  bladder,  which  he 
believed  to  have  been  caused  by  it. 

The  ordinary  dose  of  powdered  conium  is  three  or  four  grains, 
twice  or  thrice  a day,  — the  dose  being  gradually  increased,  until 
vsome  degree  of  cephalic  uneasiness  is  experienced.  The  powder, 
however,  speedily  loses  its  virtues,  and  different  specimens  appear 
to  have  different  potency  ; so  that  care  may  be  necessary,  if  a different 
specimen  of  the  same  preparation  be  given,  that  an  over-dose  be  not 
prescribed. 

EXTRAC  'TUM  CON'II,  EXTRACT  OF  HEMLOCK.  This  extract  is  prepared  from 
the  inspissated  juice, — too  much  pressure  being  avoided  — as  the 
extract,  obtained  in  this  manner,  is,  according  to  M.  Brande,  less 
active.  It  is  the  preparation  most  frequently  employed,  yet  it  is 
extremely  unequal  and  always  uncertain.  Indeed,  most  of  the  ex- 
tract of  conium  of  the  shops  is  wholly  inert.  (Pereira.)  It  is  con- 
sidered to  be  of  good  quality  only  when  it  disengages  the  odour  of 
conia,  which  is  strong  and  penetrating,  something  like  that  of  hem- 
lock, — but  more  analogous  to  that  of  a combination  of  the  odour  of 
tobacco  and  mice.  (Pereira.)  It  does  not,  however,  contain  much 
conia  at  any  time.  From  §iv  of  the  extract,  obtained  by  Dr.  Pereira 
from  one  of  the  most  respectable  druggists  in  London,  he  was  unable 
to  procure  any  sensible  quantity  of  it.  It  would  appear,  that  in  the 
process  of  evaporation  the  conia  is  decomposed  ; and  that  in  the 
very  best  extracts  it  disappears  after  they  have  been  kept  for  some 
time.  When  we  take  all  this  into  account,  with  the  differences  in 
the  plant  itself,  according  as  it  is  wild  — which  is  the  most  active  — 
or  cultivated,  or  as  it  is  culled  at  different  periods,  it  is  obvious  that 
no  great  dependence  can  be  placed  upon  the  greater  part  of  the  com- 
mercial extract.  One  cwt.  of  the  leaves  yields  from  three  to  five 
pounds  of  extract. 

The  ordinary  dose  is  two  or  three  grains  gradually  increased  until 
some  constitutional  effect  is  induced.  It  is  usually  given  in  the  form 
of  pill. 

In  place  of  the  Extract,  Dr.  Neligan,  of  Dublin,  recommends  the 
Succus  coni'iy  which  he  obtains  as  follows:  — Take  of  fresh  hemlock 
leaves  any  quantity  ; express  the  juice  in  a tincture  press  ; set  it  aside 
for  forty-eight  hours  ; pour  off  the  clear  supernatant  liquor  from'  the 
fecula  and  chlorophyll,  whrich  it  has  deposited  ; and,  lastly,  add  to 
it  a fifth  part  by  measure  of  rectified  spirit.  This  preparation  he  has 
found  to  keep  well  for  two  years.  The  dose  he  gives  is  thirty 
minims  three  times  a day  in  a little  water.  This  may  be  increased 
to  forty  or  sixty  minims,  and  be  decreased  or  wholly  withdrawn  ac- 
cording to  the  phenomena  induced.  The  most  unpleasant  effect, 
when  given  in  full  doses,  was  a disagreeable  sense  of  dryness  in 


ACONITUM. 


371 


the  throat,  accompanied  with  a feeling  of  constriction,  and  some  dif- 
ficulty of  swallowing.  When  this  was  the  case,  the  medicine  was 
omitted  for  a short  time. 

The  United  States  Pharmacopoeia  (1842)  has  an  ALCOHOL'IC  EXTRACT 
OF  HEMLOCK  — EXTRACTO  CONl'l  ALCOHOL'ICUM  — which  is  made  from 
the  dried  leaves,  like  the  alcoholic  extract  of  belladonna.  It  is  ap- 
plicable to  the  same  cases  as  the  ordinary  extract,  for  which  it  is  a 
substitute,  although  it  is  probably  even  less  satisfactory. 

TINCTU'RA  CONl'l,  TINCTURE  OF  HEMLOCK.  (Conii  foL  §iv;  Alcohol, 
dilut.  Oij  ; prepared  by  maceration  or  by  displacement.)  The  Edin- 
burgh College  prepares  a tincture  from  the  expressed  juice,  which, 
for  the  reasons  before  given,  must  be  much  more  active  than  the 
tincture  of  the  dried  leaves.  The  dose  is  from  f.  ^ss.  to  f.  5j.  A 
tincture  of  the  dried  fruit  or  seed  has  been  proposed,  which  would 
necessarily  be  more  active. 

7.  ACONI'TUM.— AC'ONITE. 

In  the  Pharmacopoeia  of  the  United  States,  (1842,)  Aconitum  is 
defined  to  mean  “ the  leaves  of  AconiHum  napell'us  and  of  A.  pani~ 
culaHum^  (De  Candolle.)”  Wolfes  hane  or  Monicas  hood.  The 
Dublin  College  adopts  A.  panicula'tum  as  officinal,  and  directs  the 
leaves  to  be  used : the  London  College  directs,  in  addition,  the  root 
to  be  employed  ; and  the  Edinburgh,  the  leaves  of  Aconi'tum  napeV- 
lus.  They  belong  to  Sexual  System,  Polyandria  Trigynia ; Nat. 
Ord.  Ranunculaceee  ; are  indigenous  in  Europe,  where  they  are  often 
cultivated  in  tUe  gardens,  and  are  seen  occasionally  in  those  of  this 
country.  The  leaves  are  usually  collected  when  the  flowers  begin 
to  appear,  or  shortly  before. 

Neither  the  leaves  nor  the  root  of  aconite  have  any  smell,  but 
when  chewed,  they  slowly  occasion  a strange  sense  of  tingling  and 
numbness  in  the  tongue  and  interior  of  the  mouth.  The  root  is 
gathered  in  the  spring,  just  before  the  leaves  appear.  The  expressed 
juice,  as  well  as  the  alcoholic  extract  of  the  leaves,  possesses  all  the 
properties  of  the  plant.  The  watery  extract  is  regarded  as  a preca- 
rious and  very  irregular  preparation. 

Aconite  yields,  on  analysis,  a peculiar  alkali  termed  Aconit’ia  or 
.dconiti^na,  and  a volatile  acrid  principle,  which  is  readily  decom^ 
posed. 

It  is  an  active  poison  of  the  acro-narcotic  class,  producing,  in  small 
doses,  the  tingling  and  numbness  already  mentioned,  and  in  larger 
doses,  symptoms  of  gastric  irritation,  accompanied  or  followed  by 
signs  of  narcosis  — as  stupor,  convulsions,  coma,  and  death. 

From  recent  observations  by  Dr.  Richard  Eades,  the  following 
were  the  most  marked  phenomena  exhibited  by  animals  to  which 
belladonna  had  been  given  : — weakness  ; staggering  ; gradually  in- 
creasing insensibility  of  the  surface  ; slowly  increasing  weakness  of 
the  voluntary  muscles  ending  perhaps  in  parffiysis ; great  languor  of 


372 


SPECIAL  NARCOTICS. 


the  pulse  ; more  or  less  blindness,  and  convulsive  twitchings  before 
death. 

Small  and  repeated  doses  of  the  alcoholic  tincture  of  the  root, 
taken  internally,  are  said  to  cause  a sensation  of  heat  and  tingling  in 
the  extremities,  and  occasionally  slight  diuresis.  Unlike  belladonna 
and  stramonium,  when  applied  to  the  eye,  it  induces  contraction  of 
the  pupil;  and  the  powers  of  the  circulation  appear  to  be  depressed 
by  it. 

Stcirck  of  Vienna  first  introduced  this  remedy,  as  well  as  others  of 
the  class,  to  the  notice  of  physicians,  and  it  was  employed  in  nume- 
rous diseases  ; the  chief  of  which  were  rheumatism,  gout,  scirrhus  and 
cancer ; but  it  is  now  rarely  administered.  Owing  to  its  sedative 
influence  on  the  circulation,  it  has  been  given  in  h}pertrophy  of  the 
heart. 

Experiments  have  been  made  by  Dr.  Fleming  to  determine  more, 
accurately  its  action.  From  a consideration  of  its  effects  on  the  cir- 
culation, he  deduces  the  following  inferences — First.  That  it  is  a 
powerful  antiphlogistic.  Secondly.  That  it  is  calculated  to  be  of 
great  value  in  all  cases  where  there  is  inordinate  activity  of  circula- 
tion. Thirdly.  That  it  is  contra-indicated  when  there  is  obvious 
mechanical  impediment  to  the  passage  of  the  blood,  particularly 
through  the  heart  or  lungs:  and — Fourthly.  That  it  is  contra-indi- 
cated wherever  there  is  irritability  of  the  circulation  with  great  dimi- 
nution of  power,  such  as  occurs  after  severe  venous  hemorrhage. 
These  inferences  apply,  however,  to  sedatives  in  general.  It  would 
appear  to  be  a remedy  of  great  power,  and  ought  to  be  administered 
with  exceeding  caution. 

In  neuralgia,  it  has  been  extravagantly  praised  by  some, — a single 
application  of  the  tincture,  it  is  said,  producing  amelioration,  and  a 
few  applications  an  entire  cure.  It  must  be  admitted,  however,  that 
it  often  fails — as  often,  indeed,  as  any  other  narcotic.  In  rheumatic 
aflfections,  it  has  also  been  of  great  service.  Those  of  the  chronic 
kind  have  been  most  benefited ; but  cases  of  acute  rheumatism  have 
likewise  been  greatly  relieved.  It  has,  also,  been  largely  employed 
externally. 

The  dose  of  powdered  aconite  is  one  or  two  grains,  which  may  be 
gradually  increased  until  its  effects  are  apparent.  When  good,  it 
causes  the  tingling  and  numb  sensation  before  described. 

Of  the  preparations  of  aconite  Dr.  Fades  thinks  the  tincture  of  the 
root,  and  the  alcoholic  extract  are  most  to  be  depended  upon.  His 
observation  induces  him  to  regard  the  alcoholic  tincture  of  the  root 
to  be  stronger  than  that  of  the  leaves. 

TINCTU'RA  ACO^'lTl,  TINCTURE  OF  AC'ONITE.  [Aconit.  giv  ; Alcohol,  dilut. 
Oij : prepared  either  by  maceration,  or  by  displacement.)  The  dose 
of  the  preparation  is  five  drops,  given  three  or  four  times  a day  ; but  its 
effects  should  be  carefully  watched.  Dr.  Male,  of  Birmingham, 
England,  took  tincture  of  aconite  for  four  days,  beginning  with  five 


ACONITIA. 


373 


drop  doses  either  twice  or  thrice  a day,  and  increasing  the  dose  to 
six,  eight  and  ten  drops,  so  that  on  the  evening  of  the  fourth  day  he 
had  taken  a dose  of  ten  drops.  On  the  morning  of  the  fifth  day,  the 
injurious  effects  of  the  remedy  on  the  nervous  system  appeared,  and 
he  died  on  the  morning  of  the  seventh  day.  It  is  applied  as  an  em- 
brocation in  neuralgia  and  rheumatism,  by  means  of  a small  piece  of 
sponge  attached  to  the  end  of  a stick.  Dr.  Pereira  states,  that  the 
use  of  an  aconite  plaster,  made  by  spreading  the  soft  alcoholic  ex- 
tract on  adhesive  plaster,  in  neuralgia,  has  been  suggested  to  him. 

EXTRAC'TUM  ACOM  TI  ALCOHOL 'ICUM,  ALCOHOLIC  EXTRACT  OF  AC'OMTE.  This 
is  made  by  distilling  off  the  alcohol  from  the  tincture  of  aconite,  until 
the  extract  has  the  proper  consistence.  The  ordinary  dose  is  one- 
sixth  of  a grain,  made  into  a pill  with  crumb  of  bread.  It  has  been 
given  to  a greater  extent  in  articular  rheumatism,  — half  a grain 
every  two  hours,  gradually  augmenting  the  dose. 

An  AMMONiATED  EXTRACT  OF  ACONITE  has  also  been  advised  to 
be  applied  externally  by  Dr.  Turnbull.  It  is  made  by  evaporating 
very  carefully,  and  at  a low  temperature,  a tincture  of  the  dried  root 
of  the  plant  to  the  consistence  of  an  extract ; adding  to  every  drachm 
of  this  eight  or  ten  drops  of  liquor  ammonise,  and  allowing  the  mix- 
ture to  stand  a short  time  in  a very  gentle  heat,  to  drive  off  the 
excess  of  ammonia.  It  is  used  in  the  form  of  ointment,  composed 
of  one  drachm  of  the  ammoniated  extract  to  three  drachms  of  lard. 
When  this  ointment  is  rubbed  upon  the  skin,  it  occasions  a pungent 
sensation  like  that  produced  by  aconitia  ointment.  In  less  severe 
cases.  Dr.  Turnbull  advises  the  application  of  a simple  saturated 
tincture  of  the  dried  roots,  with  or  without  the  addition  of  a little 
ammonia.  An  ointment  of  the  simple  alcoholic  extract  is  sometimes 
used,  composed  of  one  part  of  the  extract  to  two  parts  of  lard.  It 
may  be  spread  on  adhesive  plaster. 


Aconit'ia,  ACONITINE.  The  active  principle  of  Aconitum  has 
been  brought  forward  with  overstrained  eulogies  of  late  years.  They 
have  been  sufficient,  however,  to  introduce  a formula  for  its  prepara- 
tion into  the  last  edition  of  the  London  Pharmacopoeia.  This  consists 
in  exhausting  aconite  root  by  means  of  alcohol;  distilling  off  the  spirit 
until  the  extract  remains ; dissolving  this  in  water,  and  filtering ; 
evaporating  the  solution  to  the  thickness  of  syrup  ; adding  dilute 
sulphuric  acid  mixed  with  distilled  water  to  dissolve  the  aconitia ; 
next  dropping  in  solution  of  amm,onia,  and  dissolving  the  aconitia, 
thrown  down,  in  dilute  sulphuric  acid  ^ mixed,  as  before,  with  water; 
adding  animal  charcoal^  and  shaking ; lastly,  filtering  and  dropping 
in  solution  of  ammonia  to  precipitate  the  aconitia,  which  is  finally 
washed  and  dried. 

This  substance  is  of  a white  colour ; inodorous,  and  of  a bitter 
VOL.  I. — 32 


374 


SPECIAL  NARCOTICS. 


taste,  leaving  behind  it  an  acrid  but  not  burning  sensation  in  the 
throat.  It  is  uncrystallisable,  requires  one  hundred  and  fifty  parts 
of  water  at  the  ordinary  temperature  to  dissolve  it ; but  only  fifty 
parts  of  boiling  water. 

Aconitia  is  a most  virulent  poison  — said  to  be  the  most  so  known, 
not  even  excepting  hydrocyanic  acid,  — ‘ one-fiftieth  of  a grain,  pre- 
pared by  Mr.  Morson,  endangering  the  life  of  an  individual.  Ac- 
cording to  Dr.  Pereira,  it  produces  contraction  of  the  pupil,  when 
applied  in  a minute  portion  mixed  with  lard  to  the  eye.  According 
to  Geiger  and  Hesse,  dilatation  of  the  pupil  is  the  consequence. 
When  a small  quantity,  either  made  into  an  ointment,  or  dissolved 
in  alcohol,  is  rubbed  for  a minute  or  two  on  the  skin,  a sensation  of 
heat  and  prickling  is  experienced,  to  which  succeeds  one  of  numb- 
ness and  constriction  in  the  part,  which  lasts  from  two  or  three  to 
twelve  or  more  hours,  according  to  the  quantity  rubbed  in.  So  small 
a portion  as  the  hundredth  part  of  a grain  has  produced  a sensation, 
which  has  continued  a whole  day.  Turnbull  found,  that  unless 
these  peculiar  impressions  were  caused  by  the  aconitia,  no  benefit 
whatever  was  to  be  expected  from  it ; and  he  observes,  that  if  there 
be  the  slightest  abrasion  of  the  skin,  an  application  of  such  activity 
should  not  be  resorted  to,  and  that  it  should  be  carefully  kept  from 
coming  in  contact  with  any  of  the  mucous  membranes.  The  diseases 
in  which  it  has  been  chiefly  used  are  of  the  neuralgic  kind  ; and 
gouty  and  rheumatic  cases.  It  is  applied  either  in  solution  in  alcohol^ 
in  the  proportion  of  a grain  or  more  to  the  drachm  ; or  of  ointment 
made  by  rubbing  two  grains  of  aconitia  with  six  drops  of  alcohol,  and 
mixing  this  well  with  one  drachm  of  lard.  A small  portion  of  this 
may  be  rubbed  on  the  affected  part,  until  either  the  pain  is  relieved, 
or  the  peculiar  sensation  described  above  is  induced.  The  appli- 
cation may  be  repeated  three  or  four  times  a day  if  requisite. 

Aconitia  has  nearly  gone  out  of  use.  The  extravagance  of  the 
price,  in  Engfand  — 3s.  6d.  or  upwards  of  three  quarters  of  a dollar 
per  grain  — would,  indeed,  have  limited  its  use  had  it  been  more 
advantageous  than  it  has  proved  to  be.  It  wmuld  appear,  indeed, 
that  all  its  powers  are  possessed  by  the  tincture  of  aconite,  or  by  the 
alcoholic  extract. 

A spurious  aconitia  — according  to  Pereira  — is  found  in  the  shops, 
which  is  imported  from  France,  and  bears  the  stamp  and  label  of  a 
celebrated  French  chemical  firm.  Its  colour  is  grayish  yellow,  and 
it  is  said  to  be  inert,  or  nearly  so. 

LACTUCA'RIUM. 

Lactucarium  is  the  inspissated  juice  of  Lactu^ca  sati'va^  Lettuce; 
Sex.  Syst.  Syngenesia  Polygamia  ^Equalis.  Nat.  Ord.  Compositifi 
— a plant  whose  native  country  is  unknown  ; but  which  is  supposed 
to  be  indigenous  in  the  East  Indies,  and  is  cultivated  in  every  part 
of  the  civilised  world.  Before  the  flower-stem,  shoots  up,  the  plant 


LACTUCARIUM. 


375 


abounds  with  a bland  milky  juice ; and  afterwards  with  one  that  is 
intensely  bitter  and  milky.  When  incisions  are  made  in  the  flower- 
ing stem,  the  juice  exudes,  and,  when  collected  and  dried,  it  con- 
stitutes the  Lactuca'rium,  Thridlace  or  Lettuce  opium.  The  ancients 
w^ere  w'ell  acquainted  wflth  the  soporific  virtues  of  the  common  garden 
lettuce;  but  Dr.  J.  R.  Coxe,  of  Philadelphia,  appears  to  have  first 
proposed  the  employment  of  the  inspissated  juice  in  medicine. 

There  are  three  kinds  of  lactucarium.  The  first^  and  the  best  and 
the  most  costly,  is  obtained  from  incisions  made  in  the  stalks  as  men- 
tioned above,  whence  the  juice  exudes,  which  is  dried  in  the  air. 
This  preparation  has  a bitter  taste  ; soon  becomes  of  a brown  colour 
and  solid  ; and  has  a gummy  fracture,  but  absorbs  moisture  from  the 
air,  becoming  soft  and  clammy. 

The  second  is  obtained  by  expression  of  the  selected  stalks,  and 
subsequent  evaporation,  either  in  the  air  or  by  artificial  warmth. 
This  is  said  to  be  the  variety  most  commonly  met  with  on  the 
European  continent. 

The  third  is  prepared  in  the  same  manner  as  any  common  extract 
from  every  part  of  the  plant.  This  is  the  Thridace  of  some.  The 
first  is  the  only  one  worthy  the  attention  of  the  therapeutist.  Lactu- 
carium has  been  several  times  subjected  to  analysis  ; but  with  no  ad- 
vantage to  pharmacology.  Neither  morphia  nor  narcotia  has  been 
found  in  it. 

The  results  of  the  author’s  experience  in  regard  to  the  medical  pro- 
perties of  lactucarium  have  been  negative.  They  certainly  do  not 
enable  him  to  say,  that  it  is  possessed  of  the  sedative  and  hypnotic 
powers  that  have  been  assigned  to  it.  By  many,  it  is  conceived  to  be 
adapted  for  cases  in  which  opium  disagrees,  and  especially  for  al- 
laying the  cough  of  phthisis,  and  other  pulmonary  affections.  Being 
devoid  of  an  exciting  property,  it  has  been  given  unhesitatingly  W’hen 
the  patient  was  at  the  same  time  labouring  under  increased  vascular 
action. 

The  usual  dose  is  from  gr.  iij  to  gr.  v ; but  it  has  been  given  to 
the  extent  of  several  drachms  a day,  without  any  very  marked  effect. 
There  can  be  no  doubt,  indeed,  that  its  virtues  have  been  greatly 
exaggerated.  As  in  the  case  of  every  anodyne  and  hypnotic,  the 
dose  should  be  increased  until  the  desired  effect  is  induced.  It  has 
been  applied  externally  in  conjunctivitis,  in  the  quantity  of  four  grains 
to  the  ounce  of  water ; and,  like  other  narcotics,  has  been  formed 
into  a plaster. 

Lactu'ca  Viro'sa,  or  strong  scented  Lettuce  of  Europe,  as  well 
as  L.  ScARioLA,  possesses  properties  analogous  to  those  of  L.  sativa  ; 
It  is  affirmed,  indeed,  that  the  former  yields  a much  larger  quantity 
of  lactucarium,  and  of  superior  quality.  Lactuca  elonga'ta  or 
Wild  Lettuce^  which  is  common  in  this  country,  was  originally  intro- 
duced into  the  secondary  list  of  the  Pharmacopoeia  of  the  United 
States,  as  a substitute  for  the  lactuca  virosa  of  Europe.  The  ex- 
tract prepared  from  it  is  said  to  be  anodyne  and  hypnotic,  in  the  dose 
of  gr.  V to  gr.  XV. 


376 


SPECIAL  NARCOTICS, 
9.  HU'MULUS.— HOPS. 


Hops  are  the  strobiles  of  Hu’mulus  Lu'jmlus^  Hop  plant ; Sex. 

Syst.  Dicecia 
Pentandria  ; 
Nat.  Ord. 
UrticacccE, 
which  is  in- 
digenous in 
the  United 
States,  and 
in  Europe, 
and  flowers 
from  June  to 
August.  It 
is  extensive- 
ly cultivated 
in  this 
country,  and 
chiefly  in 
New  Eng- 
land. The 
cones  or  stro- 
biles consti- 
tute the  hops 
of  commerce, 
which  are 
gathered  in 
England  in 
September, 
and  dried  in 
kilns.  They 

have  a peculiar  smell,  and  an  aromatic  intensely  bitter  taste,  — the 
aroma  being  lost  in  process  of  time ; but  the  bitterness  continuing. 
The  bitter  taste,  and  the  aroma,  reside  chiefly  in  the  lupulinic  glands 
or  grains,  the  LUPULI'NA  or  LUTULIN  of  the  Pharmacopoeia  of  the  United 
States,  which  forms  about  a sixth  part  of  the  weight  of  dried  hops,  and 
may  be  separated  by  thrashing,  and  to  which  Dr.  Ives  considers  that 
the  hops  are  indebted  for  all  their  medicinal  virtue.  These  grains  are 
of  a cellular  texture,  and  golden  yellow  colour  Unless  carefully  dried, 
they  soon  lose  their  taste  and  smell,  and  the  aroma  is  always  im- 
paired by  keeping. 

Lupulin,  on  chemical  analysis,  yields  about  2 per  cent,  of  vola- 
tile oil  of  hops : upwards  of  ten  per  cent,  of  bitter  principle  of 
hops,  Lu'pulite^  and  50  to  55  percent,  of  resin.  The  scales  afford 
but  very  little  lupulin.  Both  they  and  the  lupulin  yield  their  virtues 
to  water  ; but  still  better  to  alcohol  — pure  or  diluted. 

The  emanations  from  hops  are  generally  considered  to  possess 


Humulus  Lupulus. 


CANNABIS  INDICA. 


377 


hypnotic  properties  ; hence  a hop  pillow  is  sometimes  used  to  invite 
sleep.  It  was  directed  in  the  case  of  George  the  Third,  of  England, 
when  he  was  affected  with  insanity  ; and  came,  on  that  account, 
much  into  use.  Dr.  Pereira  states,  that  he  has  several  times  seen  a 
pillow  of  hops  promote  sleep  ; but  the  author  has  not  been  able  to 
arrive  at  this  inference.  He  has  often  directed  it,  and  sleep  occa- 
sionally supervened  ; but  he  has  not  been  able  to  decide  that  it  was 
not  induced,  either  in  consequence  of  the  effect  of  the  imagination, 
or  independently  of  the  hops.  The  different  preparations  of  hops 
and  of  lupulin  are  certainly  most  unsatisfactory  narcotics,  and  by  no 
means  to  be  depended  upon.  Their  bitter  principle  renders  them 
valuable  tonics ; and  hence  their  use  in  ale  and  beer,  as  well  to 
communicate  a pleasant  aromatic  flavor  as  to  check  the  acetous  fer- 
mentation. Beer  is  accordingly  prescribed  as  a tonic  and  nutritive 
drink  in  many  cases. 

INFU'SM  HUIULI,  INFU'SION  OF  HOPS,  (HumuL  |ss ; ^qucB  bullient. 
Oj.)  The  dose  of  this  hop  tea,  which  is  rarely  used,  however,  is 

f-  to  f-  ?ij- 

TINCTU'RA  mi'IUlI,  TINCmB  OF  HOPS.  {HumuL  §v  ; Mcohol.  dilut. 
Oij.)  This  preparation  has  been  proposed  as  a substitute  for  lauda- 
num when  the  latter  disagrees  ; and  the  condition  of  disease,  to 
which  it  has  been  considered  best  adapted,  is  the  wakefulness  at- 
tended with  tremors  and  general  nervous  derangement,  to  which 
habitual  drunkards  are  liable,  and  which  frequently  precedes  an 
attack  of  delirium  tremens.  The  dose  is  from  f.  Jss  to  f.  3iij. 

LUPULI'nA.  — LU'PULIN. 

Lupulin  may  be  given  in  the  same  cases  as  hops,  in  the  dose 
of  gr.  vj  to  gr.  xij,  made  into  pills  by  being  rub-  Fig.  55. 

bed  in  a warm  mortar  until  they  acquire  the  proper 
consistence. 

^ TmCTU'M  LUPlIiriViE,  TINCTURE  OF  LUPULIN.  {Lupulin. 

§iv ; Alcohol.  Oij.)  The  dose  of  this  preparation  is 
f.  3j  or  f.  jij,  in  sugared  water,  or  any  mucilaginous 

^ Briedlupulinic 

Hops  are  also  used  externally  in  the  way  of  fomen- 
tation,  in  painful  attections  of  an  internal  or  external  fied.)  (Pereira.) 
character.  A dry  hop  poultice  is  often  applied  in  internal  affections 
of  the  abdomen,  — -the  hops  being  sewed  up  in  a flannel  bag,  heated 
and  placed  over  the  inflamed  part.  An  ointment  has  also  been  used 
in  cancerous  sores,  composed  of  powdered  hops  and  lard.  Lupulin 
may  be  added  to  poultices,  or  formed  into  ointmenc,  and  be  applied 
in  the  same  cases. 

10.  CAN'NABIS  IN'DICA.  — INDIAN  HEMP. 

The  term  “ Indian  Hemp”  has  long  been  appropriated  in  the 
33* 


378 


SPECIAL  NARCOTICS. 


United  States  to  the  Apocynum  cannabinum  ; and  the  name  having 
been  assigned  to  the  hemp  raised  in  India, 
occasion  has  been  given  in  Europe  and  in 
this  country  to  confusion  as  regards  the  two 
articles. 

Although  the  epithet  “ Indica”  has  been 
applied  to  the  Cannabis  of  India,  it  does  not 
appear  to  possess  any  specific  diflference  from 
common  hemp  — Can'nabis  sati'va^  — and 
accordingly,  by  most  botanists,  they  are  es- 
teemed to  be  identical. 

Its  narcotic  powers  have  been  long  known 
to  the  people  of  Southern  Africa,  South  Ame- 
rica, Turkey,  Egypt,  Asia  Minor,  India,  and 
the  adjacent  countries  of  the  Malays,  Bur- 
mese and  Siamese,  by  whom  it  is  used  in  va- 
rious forms  to  induce  intoxication.  It  is  also 
employed  extensively  in  popular  practice  in 
different  diseases.  In  certain  seasons  a resi- 
nous juice  exudes  and  concretes  on  the  leaves, 
slender  stems  and  flowers.  This  constitutes 
the  churrus  of  Nipal  and  Hindusthan,  and  in  it  reside  the  powers  of 
all  the  preparations  of  hemp.  This  resin,  cannabin,  is  very  soluble 
in  alcohol  and  ether,  and  partially  so  in  alkaline  solutions,  but  inso- 
luble in  acid  solutions.  When  pure  it  is  of  a blackish  gray  colour ; 
IS  hard  at  90°  of  Fahrenheit,  but  softens  at  higher  temperatures,  and 
fuses  readily.  It  is  soluble  in  the  fixed  and  in  the  several  volatile 
oils.  Its  odour  is  fragrant  and  narcotic  ; taste  slightly  warm,  bitter- 
ish, and  acrid.  The  dried  hemp  plant,  which  has  flowered,  and  from 
which  the  resin  has  not  been  removed,  is  called  Gunjah.  It  yields 
to  alcohol  twenty  per  cent,  of  resinous  extract,  composed  of  the 
resin — churrus  — and  green  colouring  matter.  Gunjah  is  used  for 
smoking.  The  largest  leaves  and  capsules  without  the  stalks,  con- 
stitute Sedhee,  Subjee  or  Bang,  which  is  used  to  form  with  water  an 
intoxicating  drink.  When  the  plant  is  distilled  with  a large  quantity 
of  water,  traces  of  volatile  oil  pass  over,  and  the  distilled  fluid  has 
the  powerful  narcotic  odour  of  the  plant. 

Although  the  Indian,  the  European,  and  the  American  plants  appear 
to  be  botanically  the  same,  they  are  possessed  of  very  different 
powers.  The  former  alone  appears  to  have  any  activity.  Mr.  Dono- 
van has  recently  experimented  fully  with  hemp  raised  by  himself, 
and  has  become  satisfied,  that  “ domestic  hemp  is  proved  to  be  desti- 
tute of  the  principle,  which  renders  the  Indian  plant  so  desirable  an 
excitant  to  the  voluptuous  people  of  the  East.’’ 

Dr.  O’Shaughnessy,  who  first  made  extensive  trials  with  the 
remedy,  noticed  that  the  general  effects  observed  on  man  were  alle- 
viation of  the  pain  in  most  cases,  remarkable  augmentation  of  appetite. 


Fig.  56. 


CANNABIS  INDICA. 


379 


aphrodisia  and  great  mental  cheerfulness.  The  more  violent  effects 
were  a peculiar  form  of  delirium,  and  a cataleptic  state.  Under 
the  influence  of  fourteen  grains  of  the  resinous  extract  taken  at  bed- 
time during  an  attack  of  neuralgia,  Mr.  Donovan  awoke  early  in  the 
morning  with  a rush  of  strange  sensations  through  his  head,  accom- 
panied by  a crackling  and  singing  noise,  and  a vibratory  motion  through 
his  whole  body.  These  gradually  subsided,  and  whilst  “ dozing  off” 
he  thought  an  explosion  took  place  in  his  head,  followed  by  the 
same  rushing  noise  and  vibration  as  before,  and  afterwards  by  a 
strange  metallic  sound.  Various  other  noises  succeeded.  His  sense 
of  touch  and  feeling  had  gradually  become  more  and  more  obtuse, 
until  at  length  he  lost  all  feeling,  unless  he  pinched  himself  severely. 
“ The  effects”  says  Mr.  Donovan,  “were  now  at  their  height,  and 
the  consequences  were  surprising.  I absolutely  lost  the  conscious- 
ness of  having  a body,  and  my  corporeal  existence  appeared  to  be 
comprised  within  the  head,  and  a small  portion  of  my  chest  near  the 
throat : in  these  spots  I felt  as  much  alive  as  ever,  but  all  other 
parts  were  without  feeling,  and  to  my  perceptions  annihilated.  My 
intellect  was  not  in  the  least  disturbed  ; memory  was  as  good  as 
ever.  I reasoned  well  enough;  was  conscious  of  external  objects 
as  in  perfect  health  ; but  I had  some  notion  that  if  I gave  way 
to  sleep,  I should  never  awake  in  this  world  ; yet,  strange  to  say,  I 
felt  perfectly  resigned  to  this  sudden  termination  of  existence.” 

Similar  anomalous  phenomena  where  observed  on  his  own  person 
by  an  eminent  physician  of  Philadelphia  from  a much  smaller  dose 
of  the  extract. 

Possessed  of  such  powers  Cannabis  suggested  itself  as  a remedy 
in  various  diseases.  In  cases  of  hydrophobia,  its  soothing  influence 
has  been  manifested ; but  the  testimony  is  strongest  in  regard  to  its 
efficacy  in  tetanus,  Dr.  O’Shaughnessy  gives  the  results  of  14 
cases  of  the  traumatic  form,  of  which  nine  appear  to  have  recovered  ; 
and  from  which  he  concludes,  “ that  in  the  hemp  the  profession  has 
gained  an  anti-convulsive  remedy  of  the  greatest  value.”  The  re- 
sults, however,  of  different  observers  are  by  no  means  in  accordance. 
Whilst  some  believe  it  capable  of  replacing  opium,  where  opium  dis- 
agrees ; others  have  found  it  fail  where  opium  had  failed.  Recently, 
Dr.  Lawrie,  of  Glasgow,  has  reported  its  effects  on  twenty-six  cases, 
from  which  he  draws  the  following  conclusions.  “ First,  It  seems 
to  belong  to  that  class  of  narcotics,  which  rapidly  induce  excitement 
and  intoxication,  followed  by  sleep,  neither  sound  nor  refreshing. 
Secondly.  In  a full  dose  it  acts  powerfully  on  the  heart,  causing  pal- 
pitations, and  rapid;  weak,  intermittent  pulse  ; and  on  the  nervous 
system  producing  delirium,  coma,  convulsions,  and  dilated  pupils. 
Thirdly.  Its  effects  are  generally  transitory.  In  one  case,  however, 
the  intoxication  and  dilatation  of  the  pupils  lasted  nearly  48  hours. 
Fourthly.  It  is  a very  uncertain  agent,  in  some  cases  producing  the 
most  violent  and  seemingly  dangerous  symptoms  ; in  others  being 
nearly  inert.  Fifthly.  It  very  frequently  causes  vomiting,  which. 


380 


SPECIAL  NARCOTICS. 


whether  it  occur  spontaneously  or  from  emetics,  very  speedily  relieves 
its  unpleasant  and  perhaps  dangerous  effects.  Sixthly.  Applied 
around  the  eye  it  does  not  dilate  the  pupil.  Seventhly.  It  exerted 
little  influence  on  the  few  patients  to  whom  it  was  given,  in  the  form 
of  enema.  Eighthly.  I do  not  think  it  is  a valuable  addition  to  our 
narcotic  medicines.  In  very  few  instances  did  it  act  as  an  agreeable 
soporific  and  anodyne;  in  none  did  it  succeed  when  opium  had 
failed  ; and  in  one  case  only  was  it  preferred  to  opium.  I do  not 
think  it  is  to  be  trusted  to.  JYinthly.  So  far  from  acting  generally 
as  an  anodyne,  its  effect  was  so  disagreeable,  that  the  majority  of 
those  who  took  it  once,  only  did  so  a second  time  on  compulsion, 
and  this  is  the  more  remarkable,  as  the  patients  on  whom  I experi- 
mented belong  to  a class  to  whom  stimulants  of  all  kinds  are  familiar, 
and  who  would  greedily  swallow  opium  and  spirits  to  an  unlimited 
amount.  Tenthly.  It  seemed  useful  in  two  cases  of  subacute  rheu- 
matism ; and  lastly.  It  caused  an  immediate  craving  for  food,  and 
in  a few  permanently  increased  the  appetite.” 

Professor  Miller,  of  Edinburgh,  believes  Cannabis  to  be  compara- 
tively valueless  as  an  anodyne,  as  well  as  an  hypnotic,  in  ordinary 
circumstances.  Its  virtue  seems  to  him  to  consist  in  a power  of  con- 
trolling inordinate  muscular  spasm,  which  it  exhibited  in  a case  of 
traumatic  tetanus,  reported  by  him.  Many  cases  have  been  recently 
published,  in  which  its  anti-convulsive  power  was  confirmed. 

On  the  other  hand,  Dr.  Clendinning  has  no  hesitation  in  affirming 
that,  in  his  hands,  its  exhibition  has  usually,  and  with  remarkably 
few  substantial  exceptions,  been  followed  by  manifest  effects  as  a so- 
porific or  hypnotic  in  conciliating  sleep  ; as  an  anodyne  in  lulling 
irritation  ; as  an  antispasmodic,  in  checking  cough  and  cramp  ; and 
as  a nervine  stimulant  in  removing  languor  and  anxiety,  and  raising 
the  pulse  and  spirits:  and  that  these  effects  have  been  observed  in 
both  acute  and  chronic  affections,  in  young  and  old,  male  and  female. 

The  form  in  which  Cannabis  is  usually  given  is  the  alcoholic 
EXTRACT,  which  is  by  no  means  of  uniform  strength  or  action.  The 
author  has  known  all  the  effects  induced  by  half  a grain;  whilst  in 
the  spasmodic  neurosis,  ten  or  twenty  grains  of  the  extract  of  the 
shops  are  often  needed.  It  may  be  made  into  a soft  pill,  and  be 
thus  swallowed,  or  be  chewed  by  the  patient,  and  repeated  according 
to  the  effect.  A Tincture  may  be  made  of  24  grains  of  the  Extract 
to  a fluid  ounce  of  dilute  alcohol.  Of  this,  a fluidrachm  may  be 
given  in  tetanus,  every  half  hour,  until  the  paroxysms  cease,  or  cata- 
leptic phenomena  are  induced.  In  cholera.  Dr.  O’Shaughnessy  found 
ten  drops  given  every  half  hour  check  the  vomiting  and  purging,  and 
bring  back  warmth  to  the  surface. 

11.  SPlPv'ITUS  ^'THERIS  SULPHU'RICI  COMPOS'ITUS.- compound 
SPIRIT  OF  SUPH'URIC  ETHER. 

[Esther,  sulphuric^  Oss  ; Alcohol.  Oj  : 01.  cether.  f.  3*^*) 


SPIRITUS  iETHERIS  SULPIIURICI  COMPOSITUS. 


381 


preparation,  which  is  an  imitation  of  one  described  by  Hoffmann, 
and  hence  termed  Hoffmann^s  An'odyne  Liquor^  or  Hoff'manrds  Min'- 
eral  An'odyne  Liquor^  is  regarded  by  many  — as  its  name  imports  — 
to  be  possessed,  in  moderate  doses,  of  narcotic  powers.  In  very 
large  doses,  like  alcohol,  it  is  unquestionably  narcotic.  Many  per- 
sons have  a high  opinion  of  its  anodyne  properties,  which  they  are 
disposed  to  refer  to  the  oil  of  wine  that  enters  into  its  composition. 
Others  believe,  that  it  possesses  no  other  virtues  than  the  ordinary 
sulphuric  ether.  Certain  it  is,  that  little  dependence  is  placed  upon 
it  in  cases  where  potent  anodynes  are  indicated  ; and  notwithstand- 
ing the  authority  that  has  been  brought  forward  in  its  favour,  the  au- 
thor is  compelled  to  say  — from  the  results  of  careful  experiments 
instituted  with  it  on  the  sound  and  the  sick — that  he  has  not  noticed 
in  it  any  anodyne  or  hypnotic  virtue,  except  that  which  has  been 


induced  by  the  evanescent  excitant 
It  is  added,  however,  to  other 
decided  narcotics  — as  to  lauda- 
num — its  action  preventing  the 
nausea,  which  occasionally  super- 
venes on  the  use  of  the  latter. 

The  dose  of  the  spirit  is  f.  5SS 
to  f.  5ij,  in  sugar  and  water. 


Besides  the  preceding  narco- 
tics, the  following  are  officinal  in 
the  secondary  list  of  the  Pharma- 
copoeia of  the  United  States. 

12.  Ascle'pias  Syr'iaca,  Com- 
mon Silkweedj  Milkweed ; Sex. 

Syst.  Pentandria  Digynia  ; Nat. 

Ord.  Asclepiadaceee,  is  a very  com- 
mon plant  in  this  country  ; flower- 
ing in  July  and  August.  The  root 
is  officinal,  and  is  said  to  possess 
anodyne  properties.  The  dose  of 
the  powder  is  3j,  in  divided 
doses  given  through  the  day.  It 
has,  likewise,  been  administered 
in  strong  infusion.  The  author 
has  had  no  experience  with  it. 

13.  Ly'copus,  Bugleweed^  Ly'- 
copus  Virgin' icus ; Sex.  Syst. 
Diandria  Monogynia  ; Nat.  Ord. 
Labiatse,  is  an  indigenous  herb, 
met  with  in  the  greater  part  of  the 
United  States ; flowering  in  August. 


action  of  the  ethers  in  general. 
Fig.  37. 


Lycopus  Virginicus. 

The  whole  herb  is  offlci- 


382 


SPECIAL  TETANICS. 


nal.  Its  odour  is  peculiar,  and  taste  slightly  bitter  and  nause- 
ous. It  readily  yields  its  virtues  to  water. 

Bugleweed  is  said  to  be  a mild  narcotic  ; allaying  irritation  and 
cough ; and  diminishing  the  activity  of  the  circulation.  It  is 
given  in  infusion^  [Lycop.  gj ; Aquce  hullient.  Oj.  Dose,  f.  §ss 
to  f.  but  — like  a multitude  of  other  agents  — its  virtues  are 

scarcely  sufficient  perhaps  to  warrant  its  retention  in  the  lists  of  the 
materia  medica. 


II.  TET'ANICS. 

Definition  — Modus  operand!  — Therapeutical  application  — Special  Tetanies. 


Between  the  agents  described  under  the  head  of  Narcotics,  and 
those  that  fall  under  consideration  here,  there  is  a well-marked  dif- 
ference ; for  whilst  the  former  are  anodyne  and  hypnotic  in  appro- 
priate doses,  the  latter — leaving  the  encephalon  untouched  — may 
affect  most  prominently  the  nerves  of  voluntary  motion  ; giving  rise 
to  tetanic  convulsions,  especially  in  parts  which  are  affected  with 
paralysis  ; and  only  in  excessive  doses  induce  the  ordinary  signs  of 
acro-narcotic  poisoning.  It  is  in  consequence  of  this  effect  upon 
the  nerves  that  are  distributed  to  the  muscles,  or  to  the  portions  of 
the  nervous  centres  with  which  they  are  connected,  that  this  class  of 
agents  has  been  termed,  by  some  recent  writers,  Tetanics  ; and,  to 
avoid  confusion,  the  author  has  adopted  it  rather  than  attempt  to 
suggest  another  appellation,  and  perhaps  one  that  would  not  be  more 
expressive.  Dr.  Pereira  has  called  them  also  convulsives,  and  has 
defined  them  to  be  — “ agents  which  augment  the  irritability  of  the 
muscular  fibre,  and  in  large  doses  occasion  convulsions  but  their 
action  seems  manifestly  to  be  exerted  upon  the  nerves,  and  through 
them  on  the  muscular  irritability.  The  fact,  indeed,  that  they  in- 
duce involuntary  muscular  contractions  of  the  voluntary  muscles, 
from  slight  twitchings  to  the  rigidity  of  tetanus,  according  to  the 
quantity  given,  is  sufficient  to  demonstrate,  that  the  phenomena,  re- 
sulting from  their  administration,  are  purely  nervous. 

They  are  chiefly  given  in  paralysis,  and  especially  in  the  local 
forms ; — none  of  them  being  well  adapted  for  cases  in  which  the 
cause  of  the  paralysis  is  encephalic. 


SPECIAL  TETANICS. 

1.  NUX  VOM'ICA. 

Nux  vomica  is  the  seed  of  Strychnos  JVux  Vomlica;  Sex.  Syst. 


NUX  VOMICA. 


383 


Strychnos  Nux  vomica. 


Peiitandria  Monogynia;  Nat.  Ord.  Apocynaceie,  (Lindley,] 
middling-sized  tree,  which  is  indigenous  in  5g^ 

Coromandel,  and  other  parts  of  India,  and  in 
Ceylon. 

The  wood  — Lignum  Coluhri'num^  or 
snakewood  — is  very  bitter,  and  has  been 
employed  in  the  treatment  of  intermittents ; 
and  the  bark  was  for  a longtime  known  under 
the  name  of  false  Ang;ustu'ra  or  false  Ciis~ 
pa'7'ia  bark,  and  was  at  one  time  referred  to 
Bru'cea  ferrugin'ea  or  antidysenter'ica.  The 
berry  is  round,  smooth,  of  the  size  of  a pretty 
large  apple,  and  covered  with  a smooth,  some- 
what hard  shell,  of  a rich  orange  colour,  and 
filled,  when  ripe,  with  a white,  soft  gelatinous  pulp,  containing  the 
seeds.  These  — ^ as  met  with  in  the  shops  — are  circular,  and  flat, 
nearly  an  inch  in  diameter;  concave  on  one  side;  slightly  convex 
on  the  other;  and  thickly  covered  with  short,  brown,  satiny  hairs. 
From  their  resemblance  to  buttons,  the  seeds  have  sometimes  been 
termed  Bach'elorh  Buttons,  They  are  devoid  of  smell,  but  of  an 
acrid,  and  very  bitter  taste. 

The  quantity  of  nux  vomica,  on  which  duty  was  paid  in  England, 
in  1840,  was,  according  to  Dr.  Pereira,  550  lbs.  They  are  with 
difficulty  divided  finely.  The  simplest  method  is  to  rasp,  or  to  soften 
them  well  with  steam,  and  then  slice,  dry  and  grind  them.  The 
powder  is  of  a grayish-yellow  colour,  of  a faint  sweet  odour,  and  an 
intense,  durable  bitter  taste. 

Alcohol  is  the  best  solvent;  but  dilute  alcohol  and  water  take  up 
the  bitter  active  constituents.  They  have  frequently  been  subjected 
to  analysis,  but  the  results,  obtained  by  Pelletier  and  Caventou,  are 
considered  the  most  satisfactory.  Those  gentlemen  found  them  to 
contain,  — - strychnic  or  igasuric  acid  ; strychnia  and  brucia,  in  com- 
bination with  strychnic  acid;  wax,  in  small  quantity;  concrete  oil; 
yellow  colouring  matter;  gum;  a little  starch:  bassorin,  and  woody 
fibre.  Carbonate  of  lime,  and  chloride  of  potassium,  were  found  in 
the  ashes. 

Nux  vomica  possesses  the  powder  of  exciting  the  spinal  marrow 
without  implicating,  otherwise  than  indirectly,  the  functions  of  the 
brain.  The  chief  diseases  in  which  it  is  administered,  a.s  well  as  its 
varied  effects  in  accordance  with  the  dose,  may  be  considered  under 
the  head  of  its  active  principle,  strychnia,  with  which  — - in  a the- 
rapeutical point  of  view  — it  may  be  esteemed  identical.  It  may  be 
given  in  powder,  in  the  dose  of  five  grains,  repeated  three  or  four 
times  a day,  and  gradually  increased  until  the  special  effects  of 
strychnia  on  the  muscles  are  perceptible.  The  greatest  objection  to 
this  form  is  its  uncertainty,  and  hence  the  ALCOHOL'IC  EXTRACT  has  been 
generally  substituted.  This  is  prepared  by  taking  any  quantity  of 
nux  vomica  rasped;  exhausting  it  by  repeated  maceration  in  alcohol 


384 


SPECIAL  TETANICS. 


of  .817,  and  evaporating  it  slowly  to  the  consistence  of  an  extract. 
When  this  extract  is  given  in  an  over-dose,  it  occasions  tetanic 
convulsions  and  death  ; and,  in  medicinal  doses,  in  cases  of  paralysis, 
tetanic  convulsions  and  a feeling  of  creeping  are  experienced,  which 
indicate  the  action  of  the  remedy. 

Occasionally,  it  would  seem  to  accumulate  in  the  system,  and 
afterwards  to  explode  ; death,  at  times,  supervening  with  distressing 
cerebro-spinal  phenomena ; hence  it  is  not  always  proper  in  ence- 
phalic paralysis.  It  is,  however,  in  paralysis,  general  and  local,  that 
it  is  most  frequently  administered  ; indeed,  in  all  the  cases  in  which 
its  active  principle  — strychnia  — is  given. 

The  dose  of  the  extract  — made  into  a pill  — is  one  grain,  the 
dose  being  gradually  augmented,  until  the  peculiar  effects  are  in- 
duced. It  may  be  taken  at  bed-time,  as  night  affords  the  best  oppor- 
tunity for  noticing  the  tetanic  phenomena.  Generally,  from  four  to 
six  grains  are  sufficient ; but,  at  times,  it  is  necessary  to  carry  the 
dose  to  twenty  or  thirty  grains.  Should  the  administration  of  the 
remedy  have  been  interrupted,  the  patient  ought  to  recommence 
with  the  small  doses,  and  increase  them  gradually  as  before. 

It  is  sometimes  given  in  tincture  — three  grains  of  the  extract 
being  dissolved  in  an  ounce  of  alcohol  at  .837.  It  is  given  by  drops 
in  cases  in  which  the  alcoholic  extract  itself  is  suggested : M.  Petre- 
quin  also  employs  a tincture  of  nux  vomica,  prepared  of  four  ounces 
of  the  powder  and  a quart  of  brandy^  which  is  used  altogether  exter- 
nally as  an  embrocation  to  palsied  parts.  A liniment  is  not  unfre- 
quently  prescribed  in  similar  cases,  composed  of  an  ounce  of  the 
Tincture  of  JYux  Vomica^  and  two  drachms  of  Liquor  Ammonice. 

a.  strych'nia. 

This  alkaloid  was  discovered  in  1818  by  MM.  Pelletier  and  Ca- 
ventou.  It  has  been  found  in  Sti'ychnos  JVux  vom’ica^  S.  Igna'tia^ 
S,  Coluhri’na^  and  S.  Tieude;  is  often  associated  with  brucia,  and 
always  with  an  acid.  In  the  Pharmacopceia  of  the  United  States 
(1842)  it  is  directed  to  be  prepared  by  a process  of  which  the  follow- 
ing is  the  rationale.  JVux  vomica^  rasped,  is  digested  and  boiled  in 
two  gallons  of  water ^ acidulated  with  muriatic  acid;  this  decomposes 
the  strychnate  of  strychnia  as  it  exists  in  nux  vomica,  and  a muriate 
of  strychnia  is  formed.  The  residuum  is  boiled  again  and  again  in 
acidulated  water ^ and  the  decoctions,  after  being  strained,  are  mixed 
and  evaporated  to  the  consistence  of  syrup.  Lime^  previously  mixed 
with  water,  is  now  added,  and  the  mixture  is  boiled  for  a little  while, 
frequently  stirring.  This  decomposes  the  muriate  of  strychnia,  and 
the  powder  which  is  precipitated,  is  pressed,  dried  and  powdered. 
'Fhis  powder  is  now  treated  repeatedly  with  boiling  alcohol^  until 
deprived  of  its  bitterness;  the  liquors  are  mixed,  and  the  alcohol  is 
distilled  off.  The  residue  is  mixed  wuth  water^  heat  applied,  and 
sufficient  diluted  sulphuric  acid  added  to  neutralise  and  dissolve  the 
strychnia  ; purified  animal  charcoal  is  now  added  to  deprive  it  of  its 


STRYCHNIA. 


385 


colouring  matter ; it  is  then  boiled  for  a few  minutes,  filtered  and 
crystallised.  The  sulphate  of  strychnia,  thus  formed,  is  dissolved  in 
water ^ and  sufficient  solution  of  ammonia  added  to  separate  and  pre- 
cipitate the  strychnia,  which  is  dried  on  bibulous  paper. 

Thus  obtained,  strychnia  is  a white  powder,  of  an  intensely  bitter 
taste,  almost  insoluble  in  water;  slightly  soluble  in  cold  alcohol  and 
readily  soluble  in  the  same  menstruum  when  boiling.  Although 
almost  insoluble  in  water,  it  has  a powerful  bitter  taste.  A solution 
made  in  the  cold,  and  therefore  containing  only  g-^th  part  of  its 
weight,  may  be  diluted  one  hundred  times,  and  still  retain  a very 
decidedly  bitter  taste.  It  has  an  alkaline  re-action,  and  forms,  with 
acids,  salts  that  are  mostly  crystallisable,  and  insupportably  bitter, 
and  are  more  soluble  than  pure  strychnia. 

The  action  of  strychnia  is  precisely  like  that  of  nux  vomica,  for 
which  it  is  now  pretty  generally  substituted.  In  adequate  doses,  it 
is  one  of  our  most  energetic  poisons,  producing  death  through  its 
lethiferous  action  on  the  spinal  marrow.  A case  of  this  kind,  de- 
tailed by  Dr.  Blumhardt,  of  Stuttgart,  is  given  by  the  author  at  length 
in  another  work.  [JVew  Remedies^  4th  edition,  p.  549,  Philad.  1843.) 
Morphia  appears  to  be  the  best  antidote  to  its  effects. 

It  is  in  paralysis  that  strychnia  has  been  most  prescribed  ; and 
from  the  results  of  numerous  observations,  it  would  seem,  that  it  is 
most  efficacious  in  paraplegia  ; less  so  in  hemiplegia,  although  it  has 
been  given,  at  times  with  advantage,  in  the  latter  affection.  Its  ad- 
ministration in  hemiplegia  requires,  however,  special  circumspection, 
particularly  when  the  paralysis  has  succeeded  to  apoplexy ; as  there 
has  been  reason  to  believe,  that  the  excitant  influence  of  strychnia 
has  had  some  effect  in  inducing  a recurrence  of  the  apoplexy.  It  is 
in  local  paralysis,  that  it  is  most  serviceable  — as  in  aphonia,  amau- 
rosis, paralysis  of  the  bladder,  and  rectum,  of  the  facial  nerve,  &c. 
In  high  degrees  of  paraplegia,  the  internal  use  of  the  remedy  is  some- 
times preferred  ; but  the  endermic  administration  is  more  general. 
In  paralysis  of  the  limbs,  a spot  is  selected  in  the  vicinity  of  the 
spinal  marrow.  Strychnia  has,  likewise  been  given  in  neuralgia,  trau- 
matic tetanus,  hysteria,  hypochondriasis,  dyspepsia,  chorea,  epilepsy, 
and  catalepsy  ; but  the  author  has  never  seen  any  advantage  from  it  in 
these  affections.  It  has  been  administered,  likewise,  in  dysentery 
and  diarrhoea,  and  has  been  used  endermically  as  well  as  internally 
in  cholera,  in  which  it  was  frequently  prescribed  to  allay  vomiting  ; — 
from  a quarter  to  half  a grain  being  added  to  three  ounces  of  water, 
and  this  solution  given  in  the  dose  of  a spoonful  every  hour.  A modern 
writer.  Dr.  Ryan,  asserts,  that  he  has  repeatedly  known  a few  of  the  fol- 
lowing pills  check  a profuse  diarrhoea  with  rice-coloured  evacuations, 
even  when  the  extremities  were  blue,  in  malignant  cholera.  [Strych- 
nice^  gr.  i;  Confect.  Ros.  Jss ; Pulv.  Glycyrrhiz.  9ss.  — M.  et  divide 
in  pil.  xii.  Dose,  one,  night  and  morning,  gradually  increased  to 
four  or  five  daily.)  From  its  occasional  efficacy  in  analogous  condi- 
voL.  I. — 33 


386  . 


SPECIAL  TETANICS. 


tions  of  the  digestive  mucous  membrane,  it  has  been  suggested,  that 
it  might  prove  useful  in  bronchitis. 

Strychnia  is  best  given  in  the  form  of  pill,  or  tincture.  The  dose 
is  from  -p\th  to  ^th  of  a grain,  which  may  be  gradually  increased 
until  a grain  is  taken,  or  until  its  peculiar  effects  upon  the  muscles 
are  apparent.  Should  these  be  too  severe,  they  may  be  moderated 
by  a dose  of  opium  or  morphia.  A Tincture  may  be  made  of 
Strychnia j gr.  iij  ; Alcohol^  which  is  from  six  to 

twenty-four  drops,  twdce  or  thrice  a day. 

In  the  endermic  application  of  the  remedy,  a blister  of  the  requi- 
site size  is  applied,  and  a quarter  of  a grain  is  sprinkled  twice  a day 
on  the  denuded  surface  ; the  quantity  being  slowly  increased  to  half 
a grain  or  more,  should  this  be  necessary.  When  used  endermi- 
cally,  the  preparations  of  strychnia  produce  much  more  powerful 
local  effects  than  those  of  morphia  ; they  are  apt  to  keep  the  abraded 
portions  of  the  skin  in  an  inflamed  state,  promote  suppuration  more 
than  morphia,  and  occasion  violent  itching  and  burning,  with  a feel- 
ing as  if  needles  were  run  into  the  skin. 

When  strychnia,  administered  in  larger  doses,  does  not  act  bene- 
ficially in  any  case,  it  will  be  advisable  to  discontinue  the  remedy 
for  a few  days  — after  which  smaller  doses  may  again  exert  their  in- 
fluence — rather  than  to  carry  the  dose  still  higher.  At  times,  dur- 
ing its  endermic  use,  the  blistered  surface  becomes  covered  with  a 
layer  of  coagulable  lymph,  in  consequence  of  which  the  strychnia 
does  not  make  its  appropriate  impression.  This  layer  must  be  re- 
• moved,  as  far  as  practicable,  at  each  application  ; and  as  the  vesi- 
cated surface  becomes  daily  less  and  less  sensible,  the  dose  must 
be  proportionately  increased. 

Besides  strychnia,  several  of  its  salts  are  occasionally  used  in 
medicine ; for  example,  the  Acetate,  the  Iodate,  and  the  Nitrate. 
They  are  given  in  the  same  cases  as  strychnia  itself. 

b.  bru'cia. 

From  Nux  Vomica  Bark  an  alkaloid  is  obtained  analogous  to 
strychnia.  It  is  also  associated  with  strychnia  in  the  seeds  of  nux 
vomica,  and  in  St.  Ignatius’s  bean,  and  is  combined  with  igasuric 
acid.  In  the  bark  of  nux  vomica,  however,  it  is  combined  with 
gallic  acid.  In  the  preparation  of  it  an  alcoholic  extract  of  false  an- 
gustura  bark  is  first  made,  which  is  dissolved  in  a large  quantity  of 
cold  water,  and  filtered  to  separate  the  fatty  matter.  The  colouring 
matter  is  precipitated  by  acetate  of  lead,  the  excess  of  which  is 
tlirown  down  by  sulphuretted  hydrogen  gas,  and  the  brucia  by  an 
alkaline  base,  for  which  purpose  magnesia  may  be  employed.  The 
precipitate  from  the  magnesia  is  then  washed,  dried,  and  treated 
with  alcohol,  which  lays  hold  on  the  brucia.  This  is  obtained  by 
evaporation. 

Pure  brucia  is  of  a white  colour,  and  in  crystals,  which  have  the 
form  of  oblique  four-sided  prisms.  Its  taste  is  very  bitter,  and  it 


TOXICODENDRON. 


387 


is  soluble  in  500  parts  of  boiling  water,  and  in  850  parts  of  cold. 
It  dissolves  readily  in  alcohol.  With  the  acids  it  forms  neutral 
salts. 

Brucia  acts  on  the  economy  like  nux  vomica  bark,  but  much 
more  energetically.  It  is  analogous  to  strychnia  in  its  operation, 
but  much  weaker,  — in  the  ratio  of  1 to  10  according  to  Pelletier, 
of  1 to  12  according  to  Magendie,  and  of  1 to  24  according  to 
Andral.  It  is  scarcely  ever  used,  however.  It  may  be  given  in 
pill  or  in  tincture. 

2.  AR'NICA.  — LEOPARD’S  BANE. 

Arnica  — the  root  and  herb  of  Ar'nica  monioJna  ; Sex.  Syst. 
Syngenesia  Polygamia  superflua  ; Nat.  Ord.  Compositae,  is  in  the 
secondary  list  of  the  Pharmacopoeia  of  the  United  States.  It  is 
common  in  the  Alps,  and  is  met  with  also  in  the  mountainous 
parts  of  the  north  of  Europe.  It  is  said  by  Mr.  Nuttall  to  be  found 
also  in  the  northern  regions  of  this  continent  to  the  west  of  the 
Mississippi.  The  whole  plant,  and  especially  the  root,  possesses  a 
peculiar  aromatic  unpleasant  odour,  and  an  acrid  nauseous  taste. 
The  root  yielded,  on  analysis  by  Pfaff,  volatile  oil,  acrid  resin, 
gum,  extractive,  and  woody  fibre  ; and  Dr.  A.  T.  Thomson  is  of 
opinion,  that  the  igasurate  of  strychnia  exists  in  the  plant. 

Arnica,  in  large  doses,  belongs  to  the  class  of  acro-narcotic  poi- 
sons. In  smaller  doses,  it  has  been  employed,  especially  in  Ger- 
many, in  paralysis,  as  an  excitant  to  the  nervous  system.  In  this 
country,  however,  it  is  not  much  used,  and  there  does  not  appear 
to  be  any  clear  appreciation  of  the  affections  for  which  it  is  adapted. 
Such  seems  to  be  the  case  with  the  French  practitioners.  ‘Mt 
maybe  concluded,”  — say  MM.  Merat  and  De  Lens, — ‘Mhat  we 
have  as  yet  insufficient  data  to  pronounce  positively  on  the  affec- 
tions in  which  the  arnica  can  be  unequivocally  efficacious  ; we 
must  consequently  always  bear  in  mind  its  heating  and  active 
qualities  when  we  prescribe  it.” 

The  volatile  oil  of  the  flowers  has  been  much  prescribed  in  Ger- 
many, in  old  cases  of  paralysis,  the  result  of  the  apoplectic  condi- 
tion. Schneider  mixes  four  drops  of  arnica  oil  with  half  an  ounce 
of  Hofmann’’ s 'anodyne  liquor  or  spirit  of  nitric  ether  ; and  of  this 
he  gives  from  four  to  twelve  drops  several  times  a day. 

The  Germans,  according  to  Sir  George  Lefevre,  class  arnica 
among  sacred  remedies  ; and  its  virtues  are  extolled  throughout 
two  pages  of  the  ‘‘  Pharmacopoeia  Ruthensis.’’’’  Sir  George  himself 
was  much  disappointed  in  its  effects.  It  is  much  more  uncertain 
than  strychnia  in  its  operation  ; and  he  has  known  it  exhibited 
in  large  doses  without  producing  any  sensible  results. 

3.  TOXICODEN'DRON.  — POISON  OAK. 

The  leaves  of  Rhus  Toxicodendron  ; Sex.  Syst.  Pentandria  Tri- 
gynia ; Nat.  Ord.  Terebinthaceae,  are  in  the  secondary  list  of  the 


388 


ANTISPASMODICS. 


Pharmacopoeia  of  the  Uiiiied  States.  Rhus  Toxicoden’ dron  and  Rhus 
radi'cans  or  Poison  vine,  are  mere  varieties  of  the  same  plant.  The 
Poison  Oak  is  a shrub  from  one  to  three  feet  in  height.  It  is  very 
common  in  the  United  States  from  Georgia  to  Canada,  flowering  in 
June  and  July.  The  juice,  which  issues  from  it  when  wounded, 
applied  to  the  skin,  excites  erythematous  inflammation  and  vesi- 
cation, sometimes  putting  on  the  characters  of  ordinary  local  ery- 
sipelas ; at  others,  of  herpes.  Nor  does  it  seem  to  be  necessary 
that  the  juice  of  the  plant  should  come  in  contact  with  these  plants 
to  produce  this  effect.  An  acrid  volatile  principle  appears  to  escape 
from  them,  which  causes  the  mischief.  This  generally  appears  soon 
after  exposure,  and  generally  declines  in  about  a week. 

The  leaves,  when  taken  internally  in  large  doses,  are  acro-narcotic. 
In  medicine,  their  use  has  been  almost  restricted  to  old  paralytic 
cases  dependent  upon  torpor  of  the  nerves,  — the  same  cases  as 
require  the  use  of  strychnia,  — but  they  are  not  much  prescribed. 

The  dose,  usually  given,  has  been  from  gr.  ss.  to  gr.  j.;  but  much 
larger  quantities  may  be  prescribed  without  inducing  its  disagreea- 
ble excitant  effects  on  the  nerves.  It  is  said  to  induce  twitchings 
of  the  affected  muscles  like  strychnia. 


m.  ANTISPASMO'DICS. 

Definition  of  antispasmodics — Spasm  considered — No  direct  antispasmodic — Modes 
operand!  of  the  indirect  mental  antispasmodics — Therapeutical  application  of  anti- 
spasmodics, in  tetanus,  chorea,  epilepsy,  asthma,  hooping  cough,  colic,  hysteria,  &o. 
— {Special  antispasmodics. 

Great  discrepancy  has  existed  among  therapeutical  writers  as  to 
the  precise  situation  in  which  antispasmodics  ought  to  be  placed. 
Murray  classes  them,  with  narcotics,  amongst  the  diffusible  stimu- 
lants whilst  Thomson  places  them  with  these  same  agents,  — as 
substances  that  diminish  action  secondarily.  A short  inquiry  may 
tend  to  place  them  in  their  proper  position.  They  are  usually  de- 
fined ; — “substances  that  allay  irregular  muscular  contraction,” 
and  Dr.  Paris  affirms,  that  there  are  certain  medicinal  bodies,  which 
would  appear  to  exert  a specific  control  over  spasmodic  action, 
from  whatever  cause  it  may  have  originated  : such,  he  says,  are  as- 
saletida,  galbanum,  musk,  castor,  ammonia,  valerian.  Sac.  He  pro- 
perly adds,  however,  that  “ in  a more  general  view  of  the  subject, 
we  must  admit,  that  this  class  branches,  by  indefinable  gradation, 
into  narcotics  and  tonics ; for  since  spasm  may  be  connected  with 
the  most  opposite  states  of  the  body,  it  is  very  evident,  that  many 
of  the  individuals  included  in  the  class  of  antispasmodics  can  only 
be  relative  agents  : spasm,  for  instance,  may  arise  from  excessive 
irritability,  as  from  teething,  wounds,  worms,  &c.,  in  which  case  a 
narcotic  would  prove  beneficial ; or  it  may  depend  upon  a state  of 


ANTISPASMODICS. 


389 


general  debility,  the  proper  remedy  for  which  would  be  the  admi- 
nistration of  an  aromatic  stimulant,  or  the  assiduous  exhibition  of 
some  permanent  tonic.”  — It  maybe  affirmed,  however,  that  we 
are  not  acquainted  with  a single  article  of  the  materia  medica, 
which  acts  specifically  on  the  muscular  fibre  when  in  a state  of 
spasmodic  contraction.  That  such  may  exist  cannot  be  denied,  but 
at  this  time  we  know  of  none.  They  may  all  be  regarded  as  indi- 
rect agents  ; relieving  and  removing  spasmodic  action,  in  conse- 
quence of  their  agency  being  exerted  on  other  parts  of  the  nervous 
system  than  those  concerned  in  the  irregular  muscular  contraction, 
and  thus  deriving  from  the  nervous  influence  concerned  in  the  pro- 
duction of  the  latter. 

In  order  to  thoroughly  comprehend  this  position,  it  is  proper  to  in- 
quire into  the  nature  of  spasm.  The  Greeks  gave  the  name  to  every 
kind  of  convulsion  ; and,  by  modern  nosologists,  convulsions  are 
ranked  amongst  the  ‘ spasmid  The  term  is  now  usually  applied, 
however,  to  involuntary  contractions,  especially  of  the  voluntary 
muscles  ; and  these,  again,  have  been  divided  into  tonic  spasms, 
when  they  consist  in  permanent  rigidity  of  the  muscles  concerned, 
of  which  we  have  an  example  in  common  cramp  ; — and  clonic 
spasms,  which  consist  in  alternate  contractions  and  relaxations  — 
of  which  we  have  an  example  in  the  convulsions  of  children. 

It  is  now  admitted  by  almost  all  physiologists,  that  the  muscular 
fibre,  like  every  primary  tissue  of  the  body,  is  possessed  of  excitability 
or  irritability,  — that  is,  of  a power  of  being  acted  upon  by  appropriate 
stimuli,  and  of  moving  responsive  to  such  stimuli.  This  vis  insita^ 
however,  absolutely  requires  that  it  shall  be  acted  upon  by  stimuli 
before  motion  is  perceptible.  The  muscular  filaments  of  the  voluntary 
muscles  are  supplied  with  nerves  from  some  part  of  the  cerebro- 
spinal axis,  and  along  these  nerves  the  appropriate  stimulus  is 
sent  which  rouses  them  to  contraction.  In  the  case  of  voluntary 
motion  — as  of  the  biceps  to  rafse  any  weight  attached  to  the 
hand,  or  to  the  extremity  of  the  forearm  — an  act  of  volition  is  exe- 
cuted, under  the  influence  of  which  the  portion  of  the  cerebro-spinal 
axis,  whence  the  nerves  proceed  to  the  upper  extremity,  is  excited 
to  send  the  proper  nervous  influx  along  those  nerves,  in  quantities 
strictly  in  accordance  with  the  extent  of  action,  which  the  muscle 
should  execute.  The  muscle  immediately  contracts  responsive  to 
the  stimulation.  Now,  if  any  cause  of  irritation  exist  in  the  cere- 
bro-spinal axis,  or  indeed  in  any  part  of  a nerve  distributed  to  a 
muscle,  such  irritation  may  induce  the  same  effect  as  the  act  of 
volition,  and  the  muscle  may,  in  this  manner,  be  permanently  or 
intermittently  contracted.  In  all  cases,  therefore,  spasm  appears  to 
be  a nervous  phenomenon,  and  remedies  adapted  for  its  removal 
must  exert  their  agency  on  some  part  of  the  nervous  system  — not 
on  the  muscular  fibres,  over  the  condition  of  which  they  would 
not  appear  to  have  the  slightest  control. 

They  who  admit  direct  ahtispasmodics  find  that  difficulties  environ 

33^ 


390 


ANTISPASMODICS. 


them,  the  very  nature  of  which  entangles  the  subject  in  inextricable 
confusion.  A late  writer  on  therapeutics,  Dr.  A.  T.  Thomson,  after 
entering  into  a long  and  singularly  infelicitous  disquisition  on  the 
precise  of  antispasmodics  — suggests,  as  a point  re- 

quiring consideration,  — whether  they  are  stimulants  or  sedatives  ? 
and  he  decides  that  they  are  sedatives ; “ for,”  he  remarks,  “ if  the 
irregular  or  inordinate  action  which  they  overcome  be  the  conse- 
quence of  irritation,  either  mental  or  corporeal,  it  follows  that,  in  re- 
solving spasm,  the  susceptibility  of  impression  in  the  extreme  motor 
nerves  must  be  diminished  ; and  this  can  only  be  the  result  of  a se- 
dative power.  It  may,  however,  be  affirmed,  that  this  must  either 
be  immediate  oi  consecutive  of  a previous  stimulant  operation  ; 
thence  we  can  explain,  why  some  of  those  medicines,  which 
can  only  be  regarded  as  direct  antispasmodics,  stimulate  the 
general  system,  and,  consequently  quicken  the  pulse  ; since,  like 
narcotics,  this  action  may  be  primarily  of  a stimulant  character,  and 
be  quickly  followed  by  collapse.  According  to  this  mode  of  reason- 
ing, the  same  results  may  follow  from  antispasmodics  operating  ex- 
clusively on  the  motor  nerves,  as  from  narcotics  operating  on  those 
of  sensation.” 

Without  animadverting  on  many  of  the  hypothetical  positions  con- 
tained in  this  extract  as  to  the  modus  oj^erandi  of  antispasmodics, 
and  the  parts  on  which  they  specially  act,  it  may  be  observed,  that 
every  difficulty  vanishes  when  we  regard  the  direct  ■ — for  such  only 
can  be  esteemed  antispasmodics — as  acting  only  by  virtue  of  the 

new  impression  which  they  make  on  the  gustatory  or  gastric  nerves, 
or  both,  and  thus  deriving  from  the  inordinate  action  going  on  in 
some  other  portion  of  the  nervous  system.  What,  indeed,  are  the 
reputed  direct  antispasmodics  ? — musk,  — castor,  — Dippel’s  oil, — 
oil  of  amber,  — valerian,  — assafetida,  — galbanum,  — skunk-cab- 
bage,— ethers,  &c.;  — all  substances  belonging  to  the  class  of  ex- 
citants, and  many  of  them  calculated,  in  addition,  to  make  a powerful 
impression  on  the  nerves  of  gustation,  and  olfaction:  and  what, 
again,  are  the  indirect  antispasmodics?  Dr.  Thomson  divides  them 
into  material^  including  tonics  and  narcotics  ; and,  mental^  com- 
prising fear  and  abstraction.  It  is  strange,  however,  that  he  should 
not  have  classed  blood-letting  amongst  the  material  agents,  especial- 
ly as  he  had  previously  remarked,  with  much  propriety,  that,  whether 
the  effects  of  antispasmodics  be  perceptible  very  soon  after  their  ad- 
ministration must  necessarily  depend  on  the  cause  of  the  spasm, 

whether  it  arise  from  exhaustion  and  collapse:  such,  for  example, 
as  occurs  from  blood-letting  when  the  quantity  of  the  vital  Iluid  ab- 
stracted is  more  than  the  condition  of  the  system  can  support,  in 
which  case  nothing  is  more  common  than  for  syncope  to  be  attended 
with  convulsions  ; or  whether  it  depend  on  the  opposite  state,  ful- 
ness of  the  vessels  of  the  brain,  sufficient  to  produce  epilepsy,  or  on 
some  degree  of  inflammation,  as  in  phrenitis,  which  is  sometimes  also 
attended  with  convulsions.”  “ It  should  ever  be  remembered,”  he 


MODUS  OPERANDI. 


391 


adds,  ‘‘that  although  antispasmodics  are  indicated,  and  proper  in 
the  first  state,  just  described,  yet,  that  this  class  of  medicines  is  posi- 
tively injurious,  when  the  spasmodic  action  is  the  consequence  of  in- 
flammation of  the  brain,  or  spinal  marrow,  or  their  coverings;  under 
such  circumstances,  blood-letting  and  measures  calculated  to  subdue 
the  primary  disease  are  the  means  to  be  adopted.”  One  of  the 
great  difficulties,  indeed,  in  discriminating  the  character  of  different 
diseases  of  the  convulsive  kind,  is  involved  in  the  consideration, 
whether  they  be  dependent  upon  an  inflammatory  or  congestive  con- 
dition of  vessels,  or  connected  with  exhaustion,  or  excessive  irri- 
tability of  the  nervous  system.  In  another  section,  however,  the  au- 
thor has  dwelt  on  every  thing  applicable  to  this  portion  of  the  subject, 
when  considering  the  effects  of  the  abstraction  of  blood  in  such  dis- 
eases. To  that  section  he  must  refer  the  reader.  (See  Sedatives.) 

In  ordinary  cases  of  spasmodic  action,  not  dependent  upon  any  ex- 
cited action  of  vessels,  any  thing  that  produces  a new  nervous  impres- 
sion proves  antispasmodic.  Narcotics  do  so  by  blunting  the  impres- 
sibility of  the  whole  nervous  system.  Nauseous  agents  produce  their 
effects  upon  the  olfactory  or  gustatory  nerves  ; and,  if  they  be  ex- 
citants at  the  same  time,  upon  the  nerves  of  the  stomach.  Simple  ex- 
citants and  tonics  act  on  the  same  nerves,  and  through  them  on  the 
general  system.  Nothing,  indeed,  could  better  elucidate  the  modus 
operandi  of  these  agents,  than  those  which  Dr.  Thomson  has  termed 
MENTAL  NARCOTICS  — Fear  and  Ahstr action.  He  refers  to  a striking 
instance  of  the  sanative  effect  of  fear  in  hooping-cough  kept  up  by 
habit.  The  patient,  a young  boy,  was  threatened  with  the  applica- 
tion of  a large  blister,  and  although  it  was  not  applied,  but  merely 
placed  within  his  view,  the  dread  of  it  completely  relieved  the  cough. 
Boerhaave  is  asserted  to  have  cured  epilepsy  by  taking  a red  hot 
poker,  at  the  moment  of  the  expected  attack,  and  threatening  to  push 
it  down  the  throat  if  the  patient  should  have  a fit.  Still  more  recently, 
the  same  remedy  has  been  advised  to  be  directed  towards  the  nether 
extremity  of  the  body.  In  a treatise  on  plague,  dysentery,  and  oph- 
thalmia, Dr.  Louis  Frank  recommends,  that  a dysenteric  patient 
should  be  tied  hand  and  foot  and  be  held  by  two  men,  when  — 

chirw'gus  cum  ferro  candentijjiguram  coni  fiabenti^  coram  cegroto 
compareret.^  et  id  versus  anum  dirigiret^  quasi  id  ano  intrudere 
vellet  ! ” 

All  these  are  cases  of  the  simple  revulsive  effect  of  fear,  and  in 
this  way  any  mental  emotion  may  prove  antispasmodic.  Any  form 
indeed,  of  abstraction,  or  rather  of  distraction,  is  necessarily  revel- 
lent,  and  antispasmodic.  When  Cato,  the  Censor,  reduced  luxa- 
tions, as  he  pretended,  by  certain  mystic  words,  (p.  58,)  he  diverted 
the  attention  of  the  sufferer,  prevented  inordinate  contraction  of  the 
muscles  around  the  dislocated  joint,  and  a slight  manipulation  only 
was  necessary  to  reduce  it.  At  the  present  day,  the  surgeon  is  in 
the  habit  of  employing  this  agency ; and  although  he  may  have  no 
faith  in  set  forms  of  speech,  or  in  cabalistic  expressions,  he  knows, 
that  if  he  can  concentrate  the  attention  of  the  patient,  he  may  lessen 


392 


ANTISPASMODICS, 


the  contraction  of  the  implicated  muscles,  by  diverting,  in  some 
measure,  the  nervous  influx  from  them  ; and  if  he  then  suddenly 
exerts  his  skill  at  reduction,  the  bone  occasionally  slips  readily  into 
its  place. 

The  same  kind  of  revellent  influence  is  invoked  in  cases  of  cramp. 
In  the  Table  Talk,”  of  Coleridge,  there  is  an  allusion  to  one  of 
the  popular  charms  for  cramp,  of  which  there  are  so  many.  “When 
I was  a little  boy  at  the  Blue-coat  School,  there  was  a charm  for 
one’s  foot  when  asleep  ; and  I believe  it  had  been  in  the  school 
since  its  foundation  in  the  time  of  Edward  the  Sixth.  The  march 
of  intellect  has  probably  now  exploded  it.  It  ran  thus  : — 


Foot ! foot ! foot ! is  fast  asleep  ! 

Thumb  ! thumb  ! thumb  ! in  spittle  we  steep ; 
Crosses  three  we  make  to  ease  us, 

Two  for  the  thieves,  and  one  for  Christ  Jesus. 


And  the  same  charm  served  for  a cramp  in  the  leg,  with  the  fol- 
lowing substitution : — 

The  devil  is  tying  a knot  in  my  leg  ! 

Mark,  Luke  and  John,  unloose  it,  I beg! 

Crosses  three,'’  &c. 

{Table  Talk.  ii.  33.  — American  Edit.) 

Partly  by  an  analogous  agency,  the  animal  magnetiser  operates 
his  cures,  and  change  of  air,  society,  and  scenery  exert  their  good 
effects  in  nervous  maladies.  Some  years  ago,  the  author  visited  a 
gentleman  who  had  suffered  for  some  hours  under  such  excruciating 
pain  in  the  bowels  as  to  induce  him  to  believe  that  he  was  labour- 
ing under  enteritis.  As  soon  as  the  author  had  examined  into  his 
case,  and  laughed  at  his  fears,  — under  the  new  mental  condition 
induced,  — the  colicky  spasms  rapidly  yielded,  and  in  half  an  hour 
he  was  well.  Certain  highly  nervous  and  imaginative  persons  can 
feel  pains  wherever  they  please,  and  many  an  individual,  by  the  pe- 
rusal of  cases  of  disease,  has  fancied  himself  affected  with  the  same 
sufferings  which  he  has  seen  depicted.  If,  therefore,  attention  can 
direct  the  nervous  afflux  to  a part,  it  is  obviously  of  great  moment 
so  to  impress  the  nervous  system  of  the  individual,  that  no  concen- 
tration of  the  kind  may  take  place  towards  the  suffering  organ  ; and 
this  may  be  accomplished  by  engaging  the  mind  on  some  subject  of 
entertainment  or  reflection,  or  by  impressing  the  totality  of  the  ner- 
vous system,  or  by  affecting  nerves  at  a distance  from  those  impli- 
cated. 

The  author  has  before  observed,  that  he  does  not  regard  the  direct 
or  true  antispasmodics,  as  they  have  been  termed,  to  be  worthy  of 
the  name,  and  that  he  believes  them  to  produce  their  effect  by  the 
impression  they  make  on  the  nerves  of  two  of  the  senses,  and  by 
their  stimulant  properties,  which,  — in  the  case  of  the  articles  re- 


IN  TETANUS. 


393 


ferred  to,  as  true  antispasmodics, — are  dependent  upon  animal  resin, 
empyreumatic  oil,  volatile  oil,  or  gum-resin.  It  has  been  affirmed, 
however,  that  this  view  is  negatived  by  the  fact,  that  assafetida  — 
and  the  remark  applies  to  other  articles  on  the  list  — relieves  hyste- 
ria, even  when  injected  into  the  rectum,  and  when,  of  course,  there 
can  be  no  impression  made  on  either  the  gustatory  or  olfactory 
nerves.  This  is  true ; but  the  whole  effect  appears  in  such  case  to 
be  produced  by  the  excitant  properties  of  the  gum-resin ; and  that 
this  is  the  case  is  demonstrated  by  the  fact,  that  if  \ve  throw  up  an 
excitant — which  may  never  have  been  regarded  as  an  antispasmo- 
dic  — we  produce  the  like  result.  By  either  agent,  a new  impres- 
sion is  made  on  the  nerves  of  the  rectum,  which  at  times  rouses  the 
individual  to  consciousness.  In  such  cases,  the  author  is  in  the 
habit  of  administering  an  enema  of  oil  of  turpentine,  — not,  however, 
because  he  regards  it  as  possessing  any  virtues  over  the  excitant  oils 
in  general,  or  as  entitled  in  any  respect  to  the  appellation  of  a di- 
rect or  true  antispasmodic. 

Therapeutical  Application  of  Antispasmodics. 

To  exhibit  wffiat  little  confidence  is  reposed  in  true  antispasmo- 
dics, by  practitioners  in  general  — even  by  those  who  consider  that 
such  a class  really  exists  — it  is  well  to  glance  generally  but  briefly 
at  the  different  antispasmodics  — direct  and  indirect  — that  are  em- 
ployed in  affections  of  the  nervous  system,  and  are  regarded  by  all 
as  eminently  adapted  for  them  ; — an  inquiry  wffiich  will  signally  ex- 
hibit how  much  more  the  latter  class  is  relied  on,  when  much  dis- 
ease is  present,  than  the  former.  There  is,  indeed,  but  one  morbid 
condition,  in  which  direct  antispasmodics  are  largely  employed  at  the 
present  day,  and  the  rationale  of  their  action  in  it  is  sufficiently  ma- 
nifest. 

Tetanus  affords  us  an  example  of  a tonic  spasm,  which  would 
seem  to  be  signally  adapted  to  test  their  efficacy.  The  disease  is 
seated  in  the  great  nervous  centres,  and  unfortunately  is  too  often 
totally  irremediable.  Rarely,  however,  do  we  find  musk,  or  assa- 
fetida, or  castor,  or  any  of  the  direct  antispasmodics  employed,  be- 
cause experience  has  exhibited  their  insufficiency.  Trust  is  placed 
almost  wholly  in  indirect  agents,  and  especially  in  narcotics,  of 
which  opium  is  usually  chosen ; and  it  is  astonishing  what  quanti- 
ties can  be  borne  without  the  induction  of  any  signs  of  narcosis. 
Cases  are  on  record  in  which  fifteen  or  twenty  grains  have  been 
given  every  three  hours  for  several  days  in  succession,  and  yet  but 
little  effect  has  been  produced  on  the  disease,  or  the  patient.  Under 
the  excessive  erethism  of  the  nervous  centres,  which  constitutes  the 
pathology  of  tetanus,  narcotics  do  not  produce  their  ordinary  results, 
and  the  same  remark  applies  to  cases  of  great  exaltation  in  the  ac- 
tion of  the  nervous  centres,  which  characterises  many  of  the  dis- 
eases belonging  to  the  class  JYeuroses. 


394 


ANTISPASMODTCS, 


A case  of  tetanus  algidus  or  tetanus  from  cold,  already  referred  to, 
that  fell  under  the  author’s  care  — may  serve  to  illustrate  the  mode 
in  which  antispasmodics  exert  their  agency.  A young  man,  whilst 
heated,  threw  himself  into  a river  to  bathe.  He  immediately  ex- 
perienced some  indisposition,  and,  in  a few  hours  afterwards,  was 
attacked  with  tetanus,  in  the  form  of  opisthotonos.  He  was  put  upon 
the  use  of  narcotics,  but  without  the  disease  yielding.  He  was  now 
taken  out  of  bed,  placed  in  a brook  that  ran  by  the  house,  and  pail- 
ful after  pailful  of  cold  water  was  thrown  over  him,  whenever  the 
spasms  became  violent.  Soon  after  the  adoption  of  this  treatment 
the  spasms  yielded,  and,  by  a continuance  of  it,  they  ultimately 
passed  away.  The  boy  wholly  recovered.  This  remedy  probably 
exerted  its  agency  in  the  manner  described  as  applicable  to  antispas- 
modics in  general.  It  made  a new  impression  on  the  nervous  system 
by  the  shock  that  accompanied  the  affusion,  and  thus  broke  in  upon 
the  chain  of  morbid  phenomena  seated  in  the  cerebro-spinal  system. 

Chorea  is  another  disease  in  which  the  true  antispasmodics  might 
seem  to  be  indicated,  yet  they  are  but  rarely  employed.  The  disease 
appears  to  depend  usually  upon  great  mobility  of  the  nervous  system, 
— chiefly  of  the  part  connected  with  the  nerves  distributed  to  the 
voluntary  muscles,  — united  with  diminished  impressibility  of  the 
nerves  of  some  other  parts,  as  of  the  stomach  and  intestines  : hence 
tonics  and  purgatives  are  chiefly  relied  on,  and  they  become  indirect 
antispasmodics. 

Epilepsy  is  dependent  upon  so  many  causes,  that  its  treatment  has 
to  be  varied  according  to  circumstances.  In  the  majority  of  cases, 
however — as  in  every  disease  characterised  by  periodicity  — a 
powerful  impression  made  upon  the  nervous  system  will  prevent  a 
paroxysm  ; but  the  impression  must  be  made  immediately  before  it 
is  expected.  Except  for  the  purpose  of  preventing  a paroxysm,  true 
antispasmodics  cannot  in  any  respect  be  relied  on;  but  if  a large  dose 
of  assafetida,  castor,  or  musk  were  administered  immediately  before 
the  hour  at  which  a fit  of  epilepsy  or  of  ague  were  expected,  it  might 
prevent  it.  It  is  in  such  cases  that  mental  antispasmodics  have  been 
mainly  employed.  Any  agent,  indeed,  that  excites  a new  and 
powerful  impression  — any  revellent — may  be  followed  by  the  same 
results.  Most  commonly,  epilepsy  is  attended  by  evidences  of  great 
impressibility  and  debility  of  the  nervous  system;  and  tonics  — 
especially  metallic  tonics  — are  chiefly  relied  on.  It  is  probably 
altogether  by  exciting  a new  condition  in  the  part  to  which  it  is  ap- 
plied, and  by  modifying  circulation  and  innervation,  that  a ligature, 
put  around  one  of  the  extremities,  will  at  times  arrest  a paroxysm  of 
the  disease. 

Asthma^  again,  as  elsewhere  remarked,  must  be  looked  upon  as  a 
nervous  disease  — spasmodic  in  its  character  generally,  that  is,  de- 
pendent upon  erethism  of  the  branches  of  the  pneumogastric  nerves 
distributed  to  the  bronchial  tubes,  — but  sometimes  owing  apparently 
to  something  like  paralysis  of  the  same  nervous  branches.  Hence, 


IN  HYSTERIA. 


395 


different  agents  are  effectual,  according  to  the  precise  pathological 
condition.  Commonly,  however,  narcotics  are  signally  beneficial. 
Opium  is  given  in  large  doses  ; — stramonium  is  smoked  ; — lobelia 
inflata  is  freely  administered  ; galvanism  is  employed  ; and  all  these 
are  occasionally  eminently  successful ; but  we  rarely  hear  of  the  ad- 
ministration of  direct  antispasmodics,  although  from  the  suddenness 
of  the  attacks  of  the  disease  they  might  seem  to  be  indicated,  and 
might  occasionally  be  useful.  They  are  so  completely  eclipsed  by 
the  indirect  agents  of  the  class,  that  they  are  very  rarely  employed. 

Hooping-cough^  although  a peculiar  disease,  is  somewhat  analogous 
in  its  pathology  to  the  last.  When  Nasse  bruised  and  pinched  one 
of  the  pneumogastric  nerves  in  a living  animal,  so  as  to  break  down 
the  structure  of  the  nerve,  he  found,  that  convulsive  cough  was 
excited,  like  that  of  hooping-cough.  But,  although  this  disease  is 
so  markedly  convulsive  as  to  have  received  the  name  ^^hex  convul- 
siva,^^  and  various  others  indicative  of  its  character,  none  but  indirect 
antispasmodics  have  received  the  confidence  of  the  practitioner. 
Narcotics  generally  have  been  employed,  and  of  these  belladonna 
more  frequently  perhaps  than  any  other ; but,  scarcely  ever,  assafetida, 
musk,  castor,  or  any  of  the  direct  agents  belonging  to  the  class. 

In  common  colic^  both  direct  and  indirect  antispasmodics  may  be 
at  times  advantageously  used ; and  the  same  may  be  said  of  some 
forms  of  gastrodynia.  When  these  are  dependent  upon  causes, 
which  gentle  excitants  are  capable  of  obviating,  a stimulating  gum 
resin  — like  assafetida  — may  be  employed  with  prospects  of  benefit. 
Hence  it  is  serviceable  in  flatulencies,  for  the  removal  of  which  it  is 
often  had  recourse  to,  in  popular  practice. 

It  is  only  in  hysteria,  however,  that  direct  antispasmodics  are,  at 
this  day,  much  used.  The  affection  is  cerebro>spinal,  and  the  symp- 
toms that  indicate  it  are  numerous  and  varied.  There  is  scarcely  a 
nerve  or  a ramification,  however  small,  which  does  not  occasionally 
seem  to  participate  in  the  morbid  condition.  Generally,  the  nervous 
erethism  is  chiefly  concentred  in  the  cerebro-spinal  axis,  whence 
irradiations  proceed  to  every  part  of  the  economy  ; and  the  object, 
which  the  practitioner  has  in  view,  is  to  divert  the  nervous  action  to 
some  other  portion  of  the  frame.  Hence,  he  administers  substances 
that  are  as  nauseous  as  possible,  combined  or  not  with  excitants  as 
he  may  think  proper.  With  this  view  he  prescribes  assafetida,  vale- 
rian, dracontium,*and  all  the  reputed  direct  antispasmodics,  during 
the  paroxysm  ; and  in  the  interval  adapts  his  remedial  agent  to  the 
indications  which  may  suggest  themselves. 

These  few  observations  on  the  use  of  antispasmodics  in  diseases 
in  which  they  would  appear  to  be  signally  appropriate  will  exhibit 
the  little  reliance  that  can  be  placed  upon  such  as  are  esteemed  direct 
agents  — the  antispasrnodica  vera  ; and  the  author  does  not  think  he 
can  better  terminate  the  few  remarks  he  has  considered  it  expedient 
to  make  upon  this  class,  than  by  quoting  the  conclusion  at  which  a 
therapeutical  writer  often  referred  to.  Dr.  A.  T.  Thomson,  has  ar- 


396 


SPECIAL  ANTISPASMODICS. 


rived,  after  having  occupied  several  pages  of  his  work  with  the  ex- 
planation of  the  modus  operandi  of  direct  antispasmodics.  ‘‘  From 
what  has  been  said,  it  is  evident  that  the  range  of  this  class  of  medi- 
cines (antispasmodics)  is  extremely  limited  ; and,  in  fact,  that  every 
thing  which  the  substances  placed  in  it  can  effect,  even  as  direct  anti- 
spasmodics, may  be  accomplished  by  other  orders  of  medicines  — • 
purgatives,  diaphoretics,  narcotics,  and  tonics.  At  best,  anti-spas- 
modics  can  be  regarded  only  as  auxiliaries ; and  the  spasm  and 
convulsions  are  less  to  be  considered  than  the  causes  which  induce 
them : remove  the  cause,  and  the  effect  will  cease.” 

The  author  has  been  gratified  to  find,  that  the  above  views  on  the 
agency  of  antispasmodics,  as  contained  in  the  first  edition  of  his  “ Ge- 
neral Therapeutics have  been  adopted,  with  due  acknowledgments, 
by  a recent  writer  on  the  subject.  Dr.  Spillan,  and  the  whole  article 
is  translated  in  La  Langette  Francaise^  8 Fevrier,  1839. 


SPECIAL  ANTISPASMODICS. 

I.  Excitant  Antispasmodics. 

1.  ASSAFCE'TIDA.  — ASSAFET^IDA. 

Assafetida  is  the  concrete  juice  of  Fer'ula  Assaf ce' tida ; Sex.  Syst* 
Pentandria  Digynia ; Nat.  Ord.  Umbelliferae  ; which  is  indigenous 
in  Persia,  the  mountains  of  Chorasan  and  Laar.  It  is  considered 
probable,  however,  that  assafetida  is  obtained  from  at  least  two  species 
of  plants.  Seeds  of  the  Chorasan  plant,  which  were  sent  to  London 
in  1839,  would  seem  to  have  belonged  to  three  species.  It  is  ob- 
tained by  making  incisions  into  the  upper  part  of  the  root ; the  foot- 
stalks of  the  leaves  and  the  fibres  at  the  top  of  the  root  having  been 
previously  removed.  The  juice  is  scraped  off  as  it  exudes.  The 
process  may  be  repeated  as  often  as  twelve  times  in  the  course  of  six 
weeks,  before  the  root  is  altogether  exhausted.  The  assafetida, 
gathered  from  several  plants  at  one  time,  is  united  into  masses  of 
about  one  or  two  pounds  in  weight,  and  when  farther  hardened  by 
keeping,  is  sent  to  the  ports  of  Persia  for  exportation,  or  is  consumed 
in  the  country  as  a condiment.  With  the  Orientals,  indeed,  it  is 
highly  esteemed  — being  termed  Le  manger  des  Dieux^  whilst,  on  the 
other  hand,  with  us,  it  bears  the  undignified  but  expressive  appellation 
of  DeviVs  dung,  — German,  Teufelsdreck. 

Assafetida  is  usually  sent  from  the  Persian  Gulf  to  Bombay,  whence 
it  is  exported  to  Europe.  In  1839,  the  quantity  on  which  duty  was 
paid  was  twenty-four  cwts.  That  which  we  receive  in  this  country 
is  either  brought  directly  from  India,  or  indirectly  by  the  way  of 
Great  Britain.  As  met  with  in  the  shops,  it  is  in  irregular  pieces  of 
different  sizes,  varying  generally  from  half  a pound  to  two  pounds 


ASSAFCETIDA. 


397 


and  upwards  in  weight.  The  pieces  have  an  irregular,  amygdaloid 
appearance  externally,  as  well  as  internally,  seeming  to  be  com- 
posed of  irregular  shaped  tears,  agglutinated  by  a softer  substance. 
In  the  inferior  kinds,  the  tears  are  few  in  number,  and  the  aggluti- 
nating materials  more  copious.  The  best  pieces  are  of  a yellowish 
white  colour  externally ; the  inferior  sorts  of  a brownish  red  hue. 
All  the  varieties  have  the  peculiar  alliaceous  odour,  by  which  it  is 
so  well  known  ; and  a strong,  bitterish,  somewhat  acrid  taste.  By 
exposure  to  the  air,  it  loses  its  most  striking  qualities,  and  is  best 
preserved  in  bladders,  or  in  some  close  space.  Except  in  very  cold 
weather,  it  cannot  be  reduced  to  powder,  and  then  it  is  apt  to  co- 
here. When  softened  by  heat,  it  may  be  forced  through  a cloth, 
and  in  this  way  be  freed  from  its  impurities. 

Dr.  Pereira  describes  three  varieties.  1.  Assafetida  in  the  tear, 
which  he  suggests  to  be  the  concrete  juice  of  Fer'ula  Per'sica ; 
2.  Lump  Assafe'tida^  the  kind  usually  met  with  in  the  shops,  the 
produce  of  Ferula  Assafcetida ; and  3.  Stony  Assafetida^  which  he 
has  never  met  with  in  commerce,  and  which  seems  to  contain  51.9 
per  cent,  of  gypsum. 

Assafetida  has  been  often  subjected  to  analysis,  and  its  main  con- 
stituents have  proved  to  be,  1.  Volatile  oil  of  assafetida,  which,  like  the 
essential  oils  in  general,  is  excitant,  and  possesses  the  odorous  quali- 
ties of  the  gum-resin  ; 2.  Resin  of  assafetida  ; and  3.  Gum.  Water, 
cold  or  warm,  dissolves  the  gum,  and  the  mucilage,  thus  formed, 
suspends  the  resin  and  volatile  oil.  Its  virtues  are  yielded  to  alco- 
hol, and  when  this  is  diluted  with  water,  the  hydrated  resin  is  sepa- 
rated, and  the  fluid  rendered  milky. 

Assafetida  is  the  best  example  of  what  have  been  termed  direct 
ant ispasmo dies.  It  contains  — as  has  been  seen  — a volatile  oil  of 
an  extremely  disagreeable  character,  but  which  is  powerfully  excitant, 
and  makes  a nauseous  impression  upon  the  gustatory  nerves ; and 
likewise  resin,  which  is  also  excitant. 

It  is  by  virtue  of  these  properties  — as  remarked  of  antispasmodics 
in  general  — that  it  is  highly  useful  in  diseases  in  which  it  is  import- 
ant to  make  a new  nervous  impression  ; hence  its  value  in  hysteria 
especially,  and  in  certain  cases  of  hypochondriasis.  It  is,  likewise, 
used  in  chorea  and  in  hooping-cough  ; but  although  much  testimony 
has  been  adduced  in  its  favour  in  the  latter  disease,  the  author  has 
never  seen  it  of  marked  advantage.  Hooping-cough  is  a self-limited 
affection,  and  no  remedies  can  be  productive  of  much  b.enefit  except 
as  palliatives  ; nor  has  assafetida,  in  the  author’s  experience,  effected 
this  much.  In  old  cases  of  catarrh,  it  has  been  of  service,  as  else- 
where remarked,  (p.  232,)  as  an  expectorant.  In  like  manner,  its 
excitant  properties  render  it  well  adapted  for  flatulent  colic. 

Perhaps  in  the  whole  class  of  phenomena,  termed  nervous,  there  is 
no  article  of  the  materia  medica  which  is  more  employed,  and  none 
which  is  more  satisfactory  by  reason  of  the  powerful  impression  it 
VOL.  I. — 34 


398 


SPECIAL  ANTISPASMODICS. 


makes  on  the  special  nerves  of  gustation,  as  well  as  on  those  of  the 
stomach,  and  through  them  on  the  general  system. 

The  average  dose  of  assafetida  is  ten  grains,  which,  as  an  anti- 
spasmodic,  ought  to  be  given  in  the  liquid  form,  in  order  that  all  the 
effects  of  the  remedy  may  be  exerted.  Its  operation  in  this  form  is 
likewise  more  speedy.  When  given  in  enema — as  it  not  unfre- 
quently  is,  in  torpid  conditions  of  the  bowels,  as  well  as  in  the 
paroxysm  of  hysteria  and  other  convulsive  affections  — from  half  a 
drachm  to  two  drachms  may  be  rubbed  up  with  warm  water. 

MISTU'RA  ASSAFfE'TM,  ASSAFET  IDA  MIXTURE,  (p.  233.)  The  dose  of 
this  mixture,  as  an  antispasmodic,  is  f.  ^ss  to  f.  §iss.  It  is  often 
given  in  hysteria  and  other  nervous  affections. 


mnE  ASSAFfE'TIDJ],  ASSAFET  IDA  PILLS. 


^ss.  Make  into  240  pills.] 
fetid  a. 


[Assofoet.  jiss ; Saponis, 
Each  pill  contains  three  grains  of  assa- 


PILTLE  ALOES  ET  ASSAFfE'TIDT,  PILLS  OF  ALOES  AXD  ASSAFETADil,  (p. 
173.)  Adapted  for  nervous  cases,  w’hich  are  accompanied  with  con- 
stipation. 

TINCTU'RA  ASSAFffi'TIDiE,  TINCTURE  OF  ASSAFET  IDA.  {Assafeetid.  giv  ; 
Alcohol.  Oij.)  This  tincture  possesses  all  the  virtues  of  the  assa- 
fetida, and  may  be  given  in  the  dose  of  f.  5ss  to  f.  5ij.  When 
water  is  added  to  it,  it  becomes  milky,  owing  to  the  separation  of 
hydrated  resin  ; but  the  mixture  is  efficacious. 

EMPLAS'TRUM  ASSAFfE'TM,  ASSAFETIDA  PLASTER.  (Assafedid.,  Em- 
plastr.  plumbi,  aa  tbj  ; Galban.,  Cerce  jlavce.^  aa  tbss  ; Alcohol,  dilut. 
Oiij.  The  assafetida  and  galbanum  are  dissolved  in  the  alcohol; 
the  liquor  is  strained,  and  evaporated  to  the  consistence  of  honey  ; 
the  lead  plaster  and  wax,  previously  melted,  are  then  added,  and 
evaporated  so  as  to  form  a plaster.)  This  plaster  is  applied  over  the 
stomach  or  abdomen  in  cases  of  flatulence,  especially  when  accom- 
panied by  hysteria  ; and  to  the  chest  or  between  the  shoulders,  as  an 
antispasmodic  in  hooping-cough.  It  is  exceedingly  questionable, 
however,  whether  any  of  the  virtues  of  the  assafetida  or  galbanum 
be  exerted  in  this  manner;  as  simple  rubefacient  plasters  appear  to 
be  of  the  same  efficacy. 

Assafetida  is  one  of  the  ingredients  of  the  Pilulce  galbani  compo- 
sitoi  of  the  Pharmacopoeia  of  the  United  States. 

2.  CASTO’JREUM  — CASTOR. 

This  is  a peculiar  concrete  substance  from  Castor  fiber  the  Beaver; 
order  Rodentia  ; an  inhabitant  of  northern  Russia,  and  of  the  northern 
parts  of  North  America.  Castor  is  obtained  from  two  follicles  situ- 
ate between  the  anus  and  external  genitals  of  both  sexes,  w^hich  are 
filled  with  a thick  fluid  secretion,  that  slowly  concretes  after  they  arc 
removed  from  the  animal.  They  are  generally  dried  either  by  smoke, 


VALERIANA. 


399 


or  in  the  sun ; and  are  frequently  united  by  a part  of  the  preputial 
membrane. 

Almost  all  the  castor  of  Europe  is  derived  from  North  America, 
the  Russian  being  so  very  rare  as  to  be  scarcely  ever  seen  in  Great 
Britain.  Very  little  Russian  castor  reaches  this  country  ; that  which 
is  brought  to  Philadelphia  being  derived  chiefly  from  Missouri. 
(Wood  & Bache.)  In  the  year  1839,  according  to  Dr.  Pereira,  duty 
was  paid  in  England  on  800  lbs.  — the  greater  part  being  sold  for 
exportation. 

The  American  castor  of  the  shops  is  contained  in  sacs  about  two 
inches  long  ; flattened  and  wrinkled  ; having  the  appearance  of  a 
pair  of  dried  testicles  united  by  their  spermatic  chord.  It  is  of  a 
dark  liver-brown  colour  externally ; of  a lighter  hue  internally ; of 
a resinous  fracture  ; a strong,  peculiar,  disagreeable  smell ; and  an 
aromatic  bitter,  nauseous  taste.  Alcohol  is  its  best  solvent. 

Russian  castor  is  so  scarce,  that  it  brings  a very  high  price.  Dr. 
Pereira  states,  that  he  has  paid  for  a museum  sample  £2  per  ounce  ; 
whilst  the  American  castor  brought  only  twenty  shillings  a pound. 
One  variety,  the  chalky  Russian  castor^  effervesces  when  diluted  chlo- 
rohydric  acid  is  dropped  upon  it. 

The  analysis  of  castor  has  afforded,  as  main  constituents  — a vola- 
tile oil  of  castor ; a peculiar  substance,  called  Casiorine  or  casto- 
reum  camphor,  scarcely  any  of  which  can  be  obtained  from  Ameri- 
can castor,  — and  resin,  which  has  a slight  odour  of  castor. 

Castor  is  much  less  excitant,  and  less  powerful  as  a nervine  than 
assafetida.  It  is  prescribed  in  the  same  diseases,  however.  The 
dose  is  from  gr.  x to  gr.  xx  ; but  it  is  better  given  in  tincture. 

TINCTU'RA  CASTO'REI,  TINCTURE  OF  CASTOR.  ( Castor,  cont.  §ij ; Jllcohol. 
Oij.)  The  dose  is  from  f.  5ss  to  f.  5ij. 

3.  VALERIA'NA.  — VALE'RIAN. 

Officinal  Valerian  is  the  root  of  Valeria’ na  officina'lis^  officinal  or 
great  wild  Vale'rian  ; Sex.  Syst.  Triandria  Monogynia  ; Nat.  Ord. 
Valerianaceae,  which  inhabits  wet  places,  and  sometimes  dry  banks 
in  most  parts  of  Europe,  of  which  it  is  a native.  The  root  is  dug 
up  in  the  autumn,  when  the  leaves  have  decayed.  It  is  sometimes, 
also,  collected  in  the  spring  before  the  stem  rises. 

The  rhizoma  consists  of  a tuberous  rootstalk  forming  a head, 
and  of  numerous  long,  slender,  cylindrical  fibres  issuing  from  it. 
It  has  likewise  portions  of  the  stem  attached.  The  colour  of  the 
root  is  externally  yellowish  or  brown  ; internally,  white  : the  odour 
is  strong  and  characteristic,  and  although  disagreeable  to  man,  is 
quite  the  contrary  to  cats,  which  delight  in  rolling  upon  it.  Its 
taste  is  warm,  bitter,  and  nauseous.  All  its  virtues  are  readily  com- 
municated to  water,  alcohol,  and  ammoniated  alcohol,  which  are 
the  menstrua  employed  in  the  officinal  preparations.  When  sub- 
jected to  analysis  by  Trommsdorff,  it  was  found  to  contain  volatile 


400 


SPECIAL  ANTISPASMODICS. 


oil,  which  is  its  active  constituent ; valerianic  acid,  resin,  and  resi- 
nous extractive.  The  valerianic  acid,  it  has  been  thought  probable, 
is  formed  by  the  oxidation  of  the  volatile  oil. 

Valerian,  in  large  doses,  is  excitant  to  the  nervous  system,  inducing 
headache,  mental  excitement,  hallucinations,  &c.  Its  action,  how- 
ever, in  medicinal  doses,  is  more  like  that  of  assafetida,  and  the 
other  antispasmodics  already  considered  ; and  it  is  prescribed  in 
identical  cases,  especially  in  hysteria,  and  hysteroid  affections. 

The  dose  of  the  powder  is  from  ^ss  to  ^iss,  three  or  four  times 
a day.  It  is  obvious,  that  as  the  virtues  of  the  root  reside  in  vola- 
tile oil,  neither  decoction  nor  extract,  which  would  drive  it  off,  is 
a proper  preparation.  The  infusion  is,  however,  a correct  and  good 
form.  / 

INFD'SUM  VAIERIA'NJ;,  INFU'SION  OF  VAIE'RIAN.  ( Valer.  |ss ; Jguai  bul- 
lient.  Oj.)  The  dose  of  this  is  f.  ^iss.  or  f.  §ij,  repeated  according  to 
the  urgency  of  the  phenomena. 

TINCTU'RA  VALERIA TINCTURE  OF  VALE'RIAN.  ( Valerian,  cont.  |iv  ; Al- 
cohol. dilut.  Oij.  Prepared  either  by  maceration  or  displacement.) 
The  tincture  possesses  all  the  virtues  of  the  valerian,  but  is  rarely 
given  alone,  on  account  of  the  too  excitant  effects  of  the  alcohol. 
A drachm  may  be  added  to  each  dose  of  the  infusion. 

TiNCTU'RA  Valeria™  ammonia  tt  amoniated  tincture  of  vale'rian. 

( Valerian,  cont.  5iv ; Sp.  Ammonice  aromat.  Oij  ; made  either  by 
maceration  or  displacement.)  The  addition  of  the  spirit  of  ammo- 
nia, and  the  aromatics  which  are  associated  with  it  in  the  Spirt  tus 
ammonice  aromaticus^  renders  the  valerian  a more  active  excitant  an- 
tispasmodic  than  the  simple  tincture.  It  is  an  excellent  remedy  in 
hysteria,  and  may  be  given  in  the  dose  of  f.  5]  or  f.  5ij,  diluted  with 
water,  and  sweetened. 


The  Valerianate  of  Zinc  (See  Mineral  Tonics,)  has  been  ex- 
tolled by  some  of  the  Italian  physicians  in  nervous  diseases. 

4.  GAL^BANUM. 

Galbanum  is  stated,  in  the  United  States  Pharmacopoeia,  to  be 
the  juice  of  an  unknown  plant.  It  would  seem,  that  no  sufficient 
evidence  exists  in  regard  to  its  origin  ; nor  is  the  precise  country 
where  it  is  produced  ascertained.  It  is  taken  to  Europe  partly  from 
the  Levant,  and  partly  from  India,  and  is  met  with  in  two  forms  — 
in  tears  and  in  lumps.  The  latter  is  the  form  in  which  it  is  usually 
seen,  the  lumps  being  composed  of  whitish,  reddish,  or  yellowish 
tears,  agglutinated  by  a darker  coloured  substance,  usually  mixed 
with  pieces  of  stalk,  seeds  or  other  extraneous  matter.  At  a freez- 
ing temperature,  it  is  capable  of  being  reduced  to  powder ; and  at 
the  temperature  of  boiling  water,  212,°  is  sufficiently  soft  to  admit 


BRACONTIUM. 


401 


of  being  strained.  It  has  a peculiar  balsamic  smell,  and  a hot, 
acrid,  bitter  taste.  On  analysis,  like  assafetida,  it  yields  volatile 
oil,  resin,  and  gum.  Like  the  other  gum-resins  it  forms  a milky 
mixture  with  water.  Its  properties  are  yielded  to  proof  spirit, 
which  dissolves  all  except  the  impurities. 

Galbanum  has  antispasmodic  virtues,  but  to  a less  degree  than 
assafetida ; alone,  it  is  very  little  employed,  however,  internally. 
The  dose  is  from  ten  to  twenty  grains  given  in  pill  : or  it  may  be 
formed  into  an  emulsion  with  the  addition  of  gum  arabic,  sugar, 
and  water. 

VimE  GAL  BANI  COMPOSITE],  COMPOMD  GALBANUM  PILLS.  (Galban., 
Myrrh. ^ aa  giss  ; Assafcetid.  ^ss  ; Syrup..,  q.  s.  to  form  480  pills.) 
These  pills  contain  half  a grain  each  of  galbanum,  inyrrh,  and  assa- 
fetida. They  have  been  long  known  under  the  name  of  ^ Gum  pill, 
and  have  been  much  prescribed  in  Great  Britain  in  hysterical 
habits.  Sometimes,  the  Extractum  colocynthi dis  composiium,  or 
aloes  is  added,  when  the  object  is  to  make  them  act  on  the  bowels 
at  the  same  time.  The  dose  is  from  gr.  x to  gr.  xx. 

EMPLAS'TRUM  GAL'BANI  COMPOS’ITUM,  COMPOUND  GAL  BANUM  PLASTER.  ( Gal- 
ban.  §viij  ; Emplastr.  plumbi,  tbiij  ; Terebinthin.  5x  ; Picis  abietis, 
giij.)  Used  in  the  same  cases  as  the  Emplastrum  assafoetidse ; 
but  more  commonly  as  a simple  excitant  plaster,  in  obstinate  tume- 
factions of  an  indolent  character. 

5,  DRACON'TIUM.— SKUNK  CABBAGE. 

Dracontiuin  is  the  root  of  Dracon'tium  fcedidum,  Ic'todes  fcB'iidus, 
Symplocar'pus  fce'tidus ; Sex.  Syst.  Tetrandria  Monogynia  ; Nat. 
Ord.  Aroidese,  which  is  indigenous  in  the  United  States,  growing- 
abundantly  in  meadows  and  swamps  throughout  the  whole  northern 
and  middle  sections  of  the  Union  ; flowering  in  March  and  April, 
and  somewhat  earlier  to  the  south.  Every  part  of  the  plant  has 
a disagreeable  skunky  smell,  which  resides  in  a very  volatile  prin- 
ciple that  is  dissipated  by  heat,  and  is  of  course  diminished  by 
drying.  The  root  is  in  the  secondary  list  of  the  Pharmacopoeia  of 
the  United  States.  It  is  collected  in  autumn  or  early  spring,  and 
is  carefully  dried. 

The  dried  root,  as  usually  met  with,  consists  of  the  body,  and 
the  separated  radicles.  The  odour  is  much  less  than  in  the  fresh 
root,  but  continues  for  some  time.  It  is  not,  however,  fit  for  use 
longer  than  a single  season.  When  chewed  it  is  distinctly  acrid. 
The  principle,  on  which  its  virtues  are  dependent,  is  volatile,  and 
is  dissipated  by  heat ; consequently,  decoction  is  an  inadmissible 
form. 

In  large  doses,  dracontium  is  stated  to  be  narcotic ; but  in 
medicinal  doses,  it  possesses  the  virtues  of  the  articles  already  men- 
tioned. It  may  be  given  in  the  dose  of  ten  or  twenty  grains  of 
the  powdered  root ; or  in  infusion.  A syrup  — prepared  from  the 
34* 


402 


SPECIAL  ANTISPASMODICS. 


fresh  root — is  said  to  be  a domestic  remedy.  Dracontium  is  not, 
however,  much  used,  and  the  dried  root,  as  met  with  in  the  shops, 
is  of  very  uncertain  strength. 

6.  AMMO'r^I^  PKiEPARA"TA.  — PREPARATIONS  OF  AMMO'NIA. 

All  the  preparations  of  ammonia  are  excitant,  and  antispasmodic ; 
but  the  only  one  that  is  much  prescribed,  and  the  best,  is  the 

SPIR'ITUS  AMMO'NIiE  AROMAT'ICUS,  AROMAT  IC  SPIRIT  OF  AMMO'NIA.  {Ammon, 
muriat.  Jv  ; Potassce  curb,  gviij  ; Cinnam.  contus.,  Caryophyll. 
contus.  aa  5^  i Cort.  Union.  §iv ; Alcohol.^  Aquce^  Ov.  Seven 
pints  are  distilled.)  This  is  one  of  the  forms  of  the  old  Sal  volat'ile, 
much  used  in  popular  practice,  and  in  hysteric  and  nervous  affec- 
tions in  general.  The  result  of  the  process  is  really  ammoniated 
alcohol,  impregnated  with  excitant  volatile  oils.  The  dose  is  from 
TT^xx  to  f.  5j,  given  in  sweetened  water. 

Spiritus  ammonim  aromaticus  enters  into  the  composition  of  the 
Tinctura  Guaiaci  Ammoniata,  and  the  Tinctura  ValeriancB  Ammo- 
niata  of  the  Pharmacopoeia  of  the  United  States. 

7.  ^THE/REA.—  PREPARATIONS  OF  ETHER. 

All  the  preparations  of  ether  are  excitant  and  antispasmodic.  They 
are  very  transient  and  diffusible  in  their  action,  and  well  adapted  for 
cases  in  which  the  Spiritus  Ammoniee  aromaticus  is  indicated.  In  spas- 
modic asthma,  and  other  forms  of  dyspnoea  of  a nervous  nature,  they 
often  afford  great  relief,  when  dropped  on  sugar,  and  inhaled  into 
the  air  passages.  In  all  cases  of  severe  internal  spasm,  the  pre- 
parations of  ether  are  almost  always  had  recourse  to,  either  alone  or 
associated  with  narcotics. 

1.  Aether  Sulphu'rtcus,  Sulph' uric  Ether ^ (described  under  Ex- 
citants.) The  dose  of  this  is  f.  3ss  to  f.  dropped  on  sugar,  to 
which  a little  water  is  added  ; or  it  may  be  incorporated  with  any 
aqueous  mixture,  by  rubbing  it  in  a mortar  with  two  grains  of  sper- 
maceti to  each  fluidrachm  of  the  ether. 

2.  Spib'itus  iE^THERis  Sulphu'rici  Compos'itus,  Compound  Spirit 
of  Sulph' uric  Ether,  (see  Narcotics,  p.  380.)  Hoffmann’s  anodyne 
liquor  is  more  frequently  used  as  an  antispasmodic  in  hysteric  and 
hysteroid  cases  than  any  other  of  the  ethereal  preparations.  The 
dose  is  f.  5ss  to  ^ij,  in  the  same  vehicle  as  the  aether  sulphuricus. 

3.  Spir'itus  ^E'theris  Ni'trici,  Spirit  of  JYitric  Ether,  (see  Diu- 
retics, p.  273.)  Sweet  spirit  of  nitre  has  the  virtues  of  the  prepa- 
rations already  mentioned  ; but  it  is  not  so  often  given  as  an  anti- 
spasmodic. The  dose  is  f.  3j  to  f.  3ijj  in  a little  water. 

8.  LAVAN'DULA.  — LAV'ENDER. 

Lavender  — as  elsewhere  shown  — is  an  aromatic  excitant,  (see 


MOSCHUS. 


403 


Excitants  ;)  and  when  its  volatile  oil  is  imparted  to  water,  or  to 
dilute  alcohol,  the  preparation  is  by  no  means  agreeable  to  the  taste 
of  most  persons.  It,  consequently,  along  with  its  excitant  action  on 
the  nerves  of  the  stomach,  powerfully  impresses  those  of  gustation. 
The  preparation  most  frequently  prescribed,  as  an  antispasmodic  and 
nervine,  is  the 

SPIR'ITUS  LAYANmiE  COMPOS'ITUS,  COMPOUND  SPIRIT  OF  LAV  ENDER.  (See 
Excitants.)  This  is  a favourite  agent  in  hysterical  and  hypochon- 
driacal cases,  and  is  much  used  as  a popular  remedy  in  all  cases  of 
nervous  faintness,  and  anomalous  symptoms  of  a similar  character. 
The  dose  is  f.  3ss  to  f.  3j,  dropped  on  sugar,  or  taken  in  a small 
quantity  of  sugared  water. 

9.  MOSCHUS.  — MUSK. 

Musk  is  a peculiar  concrete  juice,  obtained  from  Moschus  mos- 
chif'erus,  the  musk  animal ^ a wild  ruminating  quadruped,  rather 
larger  than  the  domestic  goat,  and  approaching  the  deer  in  its  cha- 
racters, which  inhabits  Thibet  and  other  parts  of  central  Asia,  but 
more  especially  the  Himalaya  and  Altai  mountains.  At  the  poste- 
rior part  of  its  abdomen,  a small  sac  is  situate,  immediately  under 
the  skin,  which  opens  a little  in  front  of  the  preputial  orifice  for  the 
penis,  and  is  filled  with  a thick  fluid,  particularly  abundant  in  the 
rutting  season.  This  fluid,  when  dried,  is  musk.  It  is  removed 
from  the  animal,  with  the  bag  that  contains  it,  and  is  dried  for  ex- 
portation. 

Two  kinds  of  musk  are  met  with  in  commerce,  — the  China, 
Tonquin,  or  Thibet ; and,  the  Siberian,  Russian,  or  Kabardine, 
which  is  an  inferior  kind. 

The  musk-bag  or  musk-pod  is  generally  plane  on  one  surface  ; 
convex  on  the  other,  — the  plane  surface  being  usually  bare  ; the 
convex  covered  with  brownish-yellow,  or  grayish  or  whitish  bristle- 
like stiff  hairs,  arranged  concentrically  around  the  orifice  of  the  sac  ; 
but,  at  times,  the  plane  surface  is  covered  with  hairs,  and  the  other 
is  not.  The  remains  of  the  penis  are  always  discoverable.  (Pereira.) 
The  pods  are  about  inches  long,  and  If  broad  ; and  they  weigh, 
on  an  average,  six  drachms  and  a scruple  ; and  contain  about  two 
drachms  and  forty  grains  of  musk. 

The  musk  itself,  or  grain  musk^  is  granular  — as  the  name  im- 
ports— of  an  unctuous  feel,  of  a dark  reddish-brown  colour,  and 
mixed  with  hairs.  It  has  a bitter  aromatic  taste  ; and  a characteris- 
tic smell,  which  is  agreeable  to  most  persons,  but  the  contrary  to 
some.  It  is  an  odour,  which  is  not  restricted  to  the  musk  animal, 
but  is  exhaled  by  others,  and  by  some  plants. 

The  only  invariable  distinction,  which  Dr.  Pereira  has  observed 
between  the  Chinese  and  the  Siberian  musk,  is  in  the  scent,  which 
is  much  less  powerful  in  the  latter,  and  more  nauseous  and  disa- 
greeable, being  somewhat  empyreumatic. 


404 


SPECIAL  ANTISPASMODICS. 


The  quantity  of  musk  imported  into  England  is  considerable. 
On  an  average  of  three  years,  ending  with  1832,  the  imports  of 
musk  from  all  places  eastward  of  the  Cape  of  Good  Hope,  with  the 
exception  of  China,  amounted,  according  to  McCulloch,  to  4965 
ounces  a year. 

Musk  has  been  frequently  subjected  to  analysis,  but  the  odor- 
ous principle  has  not  hitherto  been  isolated.  Artificial  pods  of  musk 
are  not  uncommonly  met  with,  of  which  Dr.  Pereira  says  he  has 
seen  several  imported  from  Canton.  This  is  called  Wampo  musk^ 
and  the  mode,  in  which  these  pods  are  distinguished  from  the 
genuine,  is  by  the  absence  of  any  aperture  in  the  middle  of  the  hairy 
coat,  the  hair  not  being  arranged  in  a circular  manner,  and  by  the 
absence  of  the  remains  of  the  penis.  The  odour  of  the  musk  in 
these  spurious  sacks  is  ammoniacal.  Musk  is,  likewise,  subjected 
to  various  admixtures,  and  especially  with  dried  blood. 

Musk  is  unquestionably  excitant,  and,  by  reason  of  its  excitant 
property,  as  well  as  by  powerfully  impressing  the  nerves  of  smell,  it 
is  antispasmodic.  Jorg  found  it  to  be  hypnotic  in  small  doses ; and 
in  large  doses  it  caused  headache,  tremors  and  even  convulsions. 
Other  observers,  however,  as  MM.  Trousseau  & Pidoux,  experi- 
enced neither  excitant  nor  hypnotic  eflfects  from  it,  but  it  appeared 
to  them  to  stimulate  the  genital  organs.  It  is  in  the  neuroses  and  in 
spasmodic  aflfections,  that  it  has  been  most  prescribed,  — for  exam- 
ple, in  hysteria,  epilepsy,  convulsions  of  children,  chorea  and  hic- 
cough ; and  it  has  been  given  in  tetanus.  Its  excitant  properties 
have  led  to  its  use  in  low  fevers,  accompanied  with  much  nervous 
debility  ; in  retrocedent  gout,  &c.  It  is  not,  however,  worthy  of  the 
reputation,  which  it  had  at  one  time,  whilst  it  is  a very  expensive 
article,  and  by  no  means  always  pure.  Hence,  it  is  not  much  em- 
ployed at  the  present  day. 

The  medium  dose  is  ten  grains,  to  be  repeated  every  two  or  three 
hours  in  the  form  of  bolus  ; or  it  may  be  suspended  in  water  by 
means  of  mucilage  of  gum  arabic  and  sugar.  It  has  been  given  in 
the  form  of  enema  in  the  convulsions  of  children. 

10.  SUC'CINUM.  — AMBER. 

The  O LEUM  SUC'CIM  RECTIFICA'TUM  or  RECTIFIED  OIL  OF  AMBER,  as 
elsewhere  shown,  is  excitant,  and  by  reason  of  its  powerful  impres- 
sion on  the  nerves  of  gustation  and  olfaction,  is  likewise  antispas- 
modic. It  has  been  given  in  the  various  neuroses,  in  which  anti- 
spasmodics  in  general  are  indicated,  in  the  dose  of  from  gtt.  v to 
gtt.  XV,  dropped  on  sugar,  or  made  into  an  emulsion  with  mucilage 
of  gum  arabic  and  sugar.  It  has  been  advised  also  locally  in  hoop- 
ing-cough, and  convulsions  of  children,  mixed  with  an  equal  portion 
of  laudanum,  and  diluted  with  three  or  four  parts  of  olive  oil  and 
brandy.  This  was  a favourite  prescription  with  the  late  Dr.  Parrish, 
of  Philadelphia. 


EMMENAGOGUES. 


405 


11.  CREASO'TUM.  — CRE'ASOTE. 

The  powerful  sensible  properties  of  this  substance,  described  else- 
where, (see  Astringents,)  would  naturally  suggest  its  employment 
as  an  excitant  antispasmodic  ; yet  it  has  not  been  much  used  as  such, 
although,  in  well  regulated  doses,  it  may  be  as  efficacious  as  any  of 
the  class.  In  certain  cases  of  neuralgia,  advantage  appears  to  have 
been  derived  from  it,  although,  in  general,  it  was  of  little  or  no 
service.  Good  effects  have  followed  its  use  in  hysteria  — of  course 
when  there  was  no  inflammatory  complication,  as  well  as  in  spas- 
modic erethism  of  the  nervous  system,  and  in  palpitation.  It  has, 
also,  been  used  with  benefit  in  hysteric  croup,  in  the  way  of  inhalation 
by  Dr.  Herndon,  of  Virginia,  — thirty  drops  being  added  to  a quart 
of  hot  water. 

The  dose  may  be  a drop  or  two  of  creasote  given  occasionally  in 
gum  water;  or  the  following  mixture  may  be  prescribed.  [Creasot. 
TT\^iv ; Aq.  camphor,  f.  §vj.  M.  Dose,  one  quarter.) 

12.  Certain  Volatile  Oils  — besides  those  already  mentioned,  as 
Oleum  Terebinthin.®:,  Dippel’s  Animal  Oil,  Oleum  Cajuputi,  &c., 
which,  along  with  their  excitant  qualities,  make  a powerful  impression 
on  the  nerves  of  gustation  and  olfaction,  are  generally  classed 
amongst  the  antispasmodics.  Their  general  properties  are  described 
elsewhere.  The  same  may  be  said  of  Camphora.  (q.  v.) 


SECTION  VII. 

AGENTS  THAT  AFFECT  PROMINENTLY  THE  ORGANS  OF  REPRO- 
DUCTION. 


I.  EMMEN'AGOGUES. 

Synox.  jyienago^a. 

Definition  of  emmenagogues  — Modus  operandi  — No  direct  emmenagogues  — Special 

einmenagogues. 

Emmenagogues  may  be  defined  — ‘‘  Agents,  that  promote  the 
menstrual  discharge.”  That  there  are  any  such  specific  agents  is  by 
no  means  established.  In  the  present  state  of  our  knowledge,  in- 
deed, we  may  affirm,  that  none  exist.  Experience  alone  has  taught 
us  this;  for  there  is  obviously  no  more  reason,  why  there  should  not 
be  substances  capable  of  exerting  a remedial  agency  on  the  organs 
concerned  in  the  function  of  menstruation,  than  that  there  should  not 
be  others,  which  exert  a cathartic  or  emetic  operation  by  their  pre- 
ference for  the  stomach  and  intestines. 

The  views  of  Dr.  Paris  on  this  division  of  medicinal  substances 
closely  correspond  with  those  of  the  author.  — ‘‘As  amenorrhoea,  or 


406 


EMMENAGOGUES. 


retention  of  the  menses,”  he  says,  ‘‘  is  generally  the  effect  of  a mor- 
bid state  of  the  body,  it  follows,  that  remedies  capable  of  acting  as 
emmenagogues  can  only  be  relative  agents,  unless  indeed  we  are 
disposed  to  accede  to  the  opinion  so  generally  maintained  in  the 
writings  of  the  older  physicians,  but  now  generally  discarded,  that 
certain  substances  exert  a specific  action  upon  the  uterus.  It  may 
certainly  be  asserted  without  fear  of  contradiction,  that  there  are 
many  substances,  which,  when  received  into  the  stomach,  have  their 
stimulant  operation  more  particularly  determined  to  one  part  than  to 
another,  — alkalies,  for  example,  to  the  kidneys  ; cantharides  to  the 
bladder  ; mercury  to  the  salivary  glands,  &c.  Reasoning  therefore 
by  analogy,  it  was  not  unphilosophical  to  conclude,  that  similar 
medicines  might  exist  with  respect  to  the  uterus ; but  experience  has 
negatived  the  supposition,  there  being  no  proof  of  any  of  the  sub- 
stances styled  emmenagogues  producing  their  effects  by  any  speciHc 
influence  upon  the  uterine  system.  If  the  term  emmenogogue  be 
assumed  conventionally,  according  to  this  view  of  the  subject,  it  may 
be  retained  without  any  fear  of  error,  otherwise  it  would  be  wiser  to 
remove  the  name  from  our  classification.” 

One  of  the  most  recent  writers  on  Materia  Medica  and  Thera- 
peutics, Dr.  A.  T.  Thomson,  has  given  us  the  following  table  of 
direct  emmenagogues,  or,  in  other  words,  of  such  as  are  supposed 
to  operate  by  their  stimulant  influence  on  the  uterus  itself,”  and  he 
has  subdivided  them,  it  will  be  observed,  into  immediate  and  me- 
diate. In  the  second  of  these  subdivisions,”  he  remarks,  “ some 
substances  will  be  found,  the  direct  influence  of  which  on  the  uterus 
is  doubtful ; they  maintain  their  place  rather  in  conformity  with  the 
prevailing  opinions,  than  from  a conviction  that  their  action  on  the  ute- 
rine system  is  such  as  to  authorise  the  position  which  they  hold,” 

“ Direct  Emmenagogues : 

1.  Immediate. 

a.  Electricity.  — Electricitas. 

2.  Mediate. 

* Organic  Products. 

b.  Oleo-Resins. — Contained  in 
Roots  — Poly  gala  Senega. 

Ruta  graveolens. 

Herb.  — Juniperus  Sabina. 

c.  Bitter  Principle.  — Contained  in 

Roots.  — Rubia  Tinctorum. 

**  Inorganic  Substances. 

d.  Mercurials.  — Prseparationes”  [Prseparata]  ‘‘  Hydrargyri.”  — 


EMMENAGOGUES. 


407 


Yet  none  of  these  agents  can  be  properly  regarded  as  producing 
their  effect  by  any  specific  operation  on  the  uterus.  The  only  one, 
which  we  know  to  operate  upon  that  organ  — inasmuch  as  we  can 
subject  the  region  directly  to  its  action  — is  electricity  ; and  it  does 
so  only  by  virtue  of  that  excitant  agency,  which  it  exerts  upon 
every  other  tissue  — not  by  a special  action,  which  can  entitle  it  to 
the  appellation  of  a true  or  direct  emmenagogue.  Dr.  Thomson’s 
doubts  of  the  propriety  of  his  own  classification,  and  of  the  admis- 
sion of  direct  emmenagogues,  is  signally  shown  in  the  following  re- 
marks, after  he  has  described  the  fancied  emmenagogue  virtues  of 
the  different  articles  comprised  in  the  list  just  cited.  “ Upon  the 
whole,  from  what  has  been  said,  it  is  obvious,  that  electricity  is  the 
only  direct  emmenagogue,  and  that  the  idea  of  the  others  acting 
upon  the  uterus  itself  is  rather  inferred  than  certain.  It  is  neverthe- 
less true,  that,  in  whatever  manner  they  act,  emmenagogues  stimu- 
late the  uterus ; and  therefore  caution  is  requisite  to  be  observed  in 
their  administration.  We  must  be  certain,  in.  the  first  place,  that 
the  suppression  is  not  connected  with  pregnancy  : in  such  a state,  it 
would  be  highly  injurious  to  prescribe  direct  emmenagogues  ; as  not 
only  abortion  may  be  induced,  but  inflammation  may  be  set  up,  and 
lay  the  foundation  of  an  organic  disease  of  the  uterus.  There  is 
often,  indeed,  much  difficulty  in  deciding  upon  the  propriety  of 
employing  direct  emmenagogues,  even  when  the  suppression  is  not 
connected  with  pregnancy : the  uterus  may  be  in  such  a state  of 
active  disease  as  to  render  their  influence  upon  it  extremely  hazard- 
ous.” 

Much  harm  has  arisen  from  a belief  in  the  existence  of  direct  em- 
menagogues, without  discriminating  the  causes  that  may  have  given 
rise  to  the  suppression  of  the  menstrual  secretion.  In  all  cases,  such 
causes  must  be  appreciated,  and  the  treatment  be  directed  to  their  re- 
moval, as  well  as  to  that  of  the  morbid  condition  of  the  general  system, 
or  of  the  uterus,  produced  by  them.  Accordingly,  emmenagogues 
must  always  be  of  an  indirect  kind,  and  the  term,  as  Dr.  Paris  has 
suggested,  should  be  retained  as  conventional,  to  express  such  an  in- 
direct operation.  Most  commonly  amenorrhoea  is  connected  with  a 
state  of  atony  of  the  general  system,  which  demands  the  use  of  exci- 
tants ; and  hence,  amongst  the  reputed  emmenagogues,  we  havealong 
catalogue  of  substances  belonging  to  the  divisions  of  excitants  proper, 
and  of  tonics.  The  oxides  and  salts  of  iron  have  been  especial 
favourites  with  the  practitioner  ; and,  accordingly,  we  find  enume- 
rated, under  the  present  divisions  of  remedial  agents,  the  carbonate, 
the  sulphate,  the  black  oxide,  the  alkaline  solution,  the  ammoniuret, 
the  tartrate,  &c.,  of  that  metal.  But,  although  atony  may  be  the 
general  cause  of  amenorrhoea,  the  disease  is  sometimes  induced  by 
an  opposite  condition  of  the  system,  in  which  excitants  would  be 
manifestly  improper,  and  remedies  of  another  kind  be  clearly  indi- 
cated. This  is  not  the  place  to  inquire,  whether  menstruation  be  a 
process  of  secretion,  or  of  simple  transudation  of  blood  through  the 


408 


EMMENAGOGUES. 


parietes  of  the  vessels  of  the  uterus.  The  author  has  elsewhere  ex- 
pressed the  opinion,  {Human  Physiology^  5th  edit.,  vol.  ii.,  p.  343. 
Philada.  1844,)  that  the  fluid  differs  somewhat  from  mere  blood  ; but 
whether  we  regard  it  in  this  light,  or  as  a periodical  hemorrhage, 
it  is  clear,  that  the  lining  membrane  ol  the  uterus,  with  the  rest  of 
the  internal  genital  apparatus,  must  be  a centre  of  fluxion,  nervous 
and  vascular,  during  the  period  of  the  flovr ; and  if  any  powerful 
mental  impression  be  made,  when  the  discharge  is  about  to  take 
place  ; or  a source  of  morbid  irritation  be  present  in  any  viscus  ; 
or  if  there  be  undue  erfergy  in  the  system  generally,  and  in  the 
uterus  in  particular,  — or  an  opposite  state  ; the  due  concentration 
of  nervous  and  vascular  energy  towards  the  uterine  system  may 
be  interfered  with,  and  amenorrhcea  supervene,  and  continue  until 
such  distracting  cause  is  removed. 

From  what  has  been  observed  regarding  the  conditions  of  the 
general  system,  which  may  occasion  amenorrhoea,  it  will  be  easy  to 
understand,  that  the  plan  of  medication  must,  in  all  cases,  vary,  ac- 
cording to  the  state  of  the  general  health.  But  remedies  may  be  ad- 
ministered as  emmenagogues,  which  act  little  on  the  general  system, 
and  affect  the  uterus  by  contiguous  sympathy  chiefly.  Thus,  if  that 
viscus  be  in  a state  of  asthenia,  a diuretic  or  local  stimulant  to  the 
kidneys  may  prove  emmenagogue  ; and,  in  the  same  manner,  a ca- 
thartic, especially  one  that  acts  on  the  lower  portion  of  the  intestinal 
canal,  may  excite  the  uterus  to  the  point  appropriate  for  the  fulfil- 
ment of  its  healthy  functions.  On  these  grounds,  aloes,  as  else- 
where seen,  has  acquired  its  reputation  as  an  emmenagogue,  and 
there  is,  perhaps,  no  article  of  the  materia  medica  which  has  been 
so  extensively  administered  with  this  view.  It  appears  to  have  no 
direct  operation  on  the  uterus  : its  agency  is  confined  to  its  cathar- 
tic powers,  — the  local  stimulation,  thus  induced,  extending  by  con- 
tiguous sympathy  to  the  uterus,  and,  in  this  indirect  manner,  occa- 
sionally producing  a restoration  of  the  suppressed  secretion. 

Formerly,  the  condition  of  the  uterus  was  looked  upon  as  exert- 
ing a predominant  influence  on  the  rest  of  the  economy,  and  as  the 
cause  of  various  morbid  phenomena,  wdiich  could  not  well,  in  the 
existing  state  of  knowledge,  be  referred  to  any  other  agency.  The 
protean  symptoms  of  hysteria,  as  the  name  imports,  were  all  consi- 
dered to  be  engendered  in  the  uterus.  The  name,  still  retained,  and 
the  terms  prasfocatio  matricis^  vapores  uterini^  strangulatio  uterina^ 
and  the  German  names  mutter krankheit^  mutterbeschwerden,  and  mut- 
terheschwerung ^ — from  mutter^  “ the  uterus,”  — sufficiently  indicate 
the  supposed  seat  of  the  mischief.  It  is  now  admitted  to  be  caused 
by  cerebro-spinal  irritation,  connected  in  particular  cases  wdth  ute- 
rine disturbance,  — such  disturbance,  however,  appearing  to  act  in- 
directly only,  by  producing,  or  developing  general  nervous  irrita- 
bility ; and  this  view  is  confirmed  by  the  fact,  that  well  marked 
hysteria  is  occasionally  met  with  in  men. 

The  condition  of  the  uterine  functions  has  always  to  be  looked 


SPECIAL  EMMENAGOGUES. 


409 


to,  — especially  in  chronic  diseases,  — but  experience  has  shown, 
that  any  aberration  of  those  functions  is  more  frequently  the  conse- 
quence than  the  cause  of  such  diseases.  The  author  cannot,  indeed, 
conclude  the  consideration  of  emmenagogues  better  than  by  quoting 
the  following  apposite  remarks  of  a writer  already  cited,  Dr.  Thom- 
son, at  the  termination  of  his  investigation  into  the  properties  usually 
assigned  to  this  class  of  remedies.  ‘‘  The  importance  of  the  cata- 
menia in  preserving  the  health  of  the  female  habit  is  undeniable  ; 
and  therefore  every  thing  that  can  tend  to  maintain  its  regular  re- 
turn, and  to  promote  its  due  quantity,  is  of  great  importance  in  a 
practical  point  of  view.  In  every  chronic  complaint  of  a female  it 
is  requisite  to  ascertain  the  state  of  the  catamenia ; but,  before  ad- 
vising any  medicine  for  the  purpose  of  influencing  the  uterus  in  any 
manner,  the  cause  of  the  suppression  or  the  irregularity,  of  what- 
ever description  it  may  be,  must  be  minutely  investigated.  Without 
obtaining  such  a knowledge  of  the  state  of  the  organ,  and  ascer- 
taining how  far  the  suspension  or  irregularity  is  due  to  the  condi- 
tion of  the  organ  itself,  or  to  the  general  system,  our  practice  must 
ever  be  uncertain  : in  floundering  about,  and  trying  various  reme- 
dies, without  rule  or  discrimination,  we  may,  it  is  true,  stumble  by 
accident  oni something  effectual  ; but  much  evil  may  be  produced.’’ 

The  local  means,  that  are  most  frequently  employed  with  the  view 
of  soliciting  the  blood  towards  the  uterus,  or  the  lower  part  of  the 
body  — are  pediluvia  and  semicupia  ; fomentations  to  the  generative 
organs  ; warm  injections  into  the  vagina  or  rectum  ; leeches  to  the 
pudendum  and  inner  sides  of  the  thighs  ; cupping  over  the  latter  re- 
gion; and  bleeding  from  the  feet ; but  these,  to  be  useful,  ought  to 
be  employed  about  the  expected  period  of  recurrence  of  the  cata- 
menia, and  especially  when  general  or  local  polysemia  exists.  Fric- 
tions have,  likewise,  been  made  over  the  lower  extremities,  and 
electricity — as  will  be  seen  — has  been  used  to  arouse  the  uterus, 
where  there  has  been  reason  to  suspect  torpor  of  that  viscus. 

Whatever  agents  are  employed,  must  be  prescribed  with  due  cau- 
tion, and  with  proper  attention  to  the  pathological  condition  that 
gives  occasion  to  the  amenorrhoea. 


SPECIAL  EMMENAGOGUES. 

I.  Cathartic  Emmenagogues. 

1.  A'LOE.  — AL'OES. 

Under  another  head,  (p.  171),  it  was  shown,  that  the  cathartic 
effect  of  aloes  is  exerted  chiefly  on  the  lower  part  of  the  intestinal 
canal;  and  it  has  been  just  remarked,  (p.  408,)  that  by  contiguous 
sympathy,  it  may  excite  the  uterus,  so  as  to  favour  the  recurrence  of 
the  menstrual  secretion,  when  it  has  been  arrested  by  any  cause 
VOL.  I. — 35 


410 


SPECIAL  EMMENAGOGUES. 


which  a local  excitant  is  capable  of  removing ; its  action  on  the 
rectum,  and  extension  of  this  action  to  the  uterus,  producing  a state 
of  the  organ  closely  allied  to  that  which  is  the  result  of  the  appli- 
cation of  a direct  stimulus.”  (A.  T.  Thomson.)  It  has  been  affirmed, 
however,  that  aloes  has  a decided  tendency  to  the  uterine  system, 
and  Dr.  Wood  adds,  that  he  can  see  no  reason  why  the  medicine 
should  not  act  specifically  upon  the  uterus,  and  that  its  influence  in 
promoting  menstruation  is  by  no  means  confined  to  cases  in  which 
its  action  upon  the  neighbouring  intestine  is  most  conspicuous.  It 
is  true  there  is  no  reason ; but,  at  the  same  time,  there  appears  to  be 
no  adequate  evidence,  that  any  such  special  action  on  the  uterus  is 
exerted  by  aloes ; and  it  certainly  has  not  seemed  to  the  author  to  be 
more  efficacious  than  other  excitant  agents  thrown  into  the  rectum 
in  restoring  the  catamenia.  Cullen  was,  indeed,  of  opinion,  that  it 
rarely  succeeds;  and  most  unquestionably  it  often  fails;  — more 
frequently  than  could  well  happen,  if  any  special  action  were  exerted 
by  it  upon  the  uterine  vessels. 

When  not  given  in  the  form  of  enema,  which,  in  the  London 
Pharmacopoeia,  is  directed  to  be  made  of  Aloes,  ^ij ; Carbonate  of 
potassa,  gr.  xv;  Decoction  of  barley,  Oss,  — a short  time  before  the 
expected  return  of  the  catamenia,  — one  of  the  following  formulae 
may  be  prescribed,  for  two  or  three  days  prior  to  the  expected  men- 
strual period. 

PIL'M  AL'OES  ET  MYRRHJ],  PILLS  OF  AL'OES  AND  MYRRH,  (p.  173.) 
These  pills,  commonly  called  Rufuses  Pills,  are  given  in  the  dose  of 
ten  to  twenty  grains. 

PELVIS  AL'OES  ET  CANEL'LJ,  POWDER  OF  ALW  AND  CANEL'LA,  (p.  173.) 
This  powder  so  long  known  under  the  name  Hiera  Picra,  or  ‘‘the 
holy  bitter”  — vulgarly  pronounced  Ilikry  Pikry  — is  a popular 
remedy  in  amenorrhoea,  either  taken  alone  or  mixed  with  wine  or 
brandy.  Its  dose  is  from  ten  to  twenty  grains. 

TINCTU'RA  AL'OES  ET  MYRRHT],  TINCTERE  OF  AL'OES  AND  MYRRH,  (p.  173.) 
The  properties  of  this  tincture  are  like  those  of  the  Pilulce  Aloes  et 
Myrrhce.  The  dose  is  f.  Jss  to  f.  ^ij. 

VINEM  AL'OES,  VYINE  OF  AL'OES,  (p.  173.)  The  dose  of  this  in 
amenorrhoea  is  f.  5i  to  f.  5ij. 

Besides  aloes,  other  cathartics,  as  colocynth,  gamboge,  rhubarb, 
and  croton  oil,  are  occasionally  administered  as  emmenagogues,  but 
by  no  means  so  frequently  as  it. 

2.  HELLEB'ORUS. —BLACK  HEL'LEBORE. 

This  is  the  root  of  Helleb’orus  JViger,  Black  Hel'lebore,  or  Christ- 
mas Rose;  Sex.  Syst.  Polyandria  Polygynia ; Nat.  Ord.  Ranuncu- 
lacese ; an  herbaceous  plant,  which  is  a native  of  various  parts  of 


HELLEBORUS. 


411 


Greece,  as  well  as  of  the  Levant,  and  inhabits  sub-Alpine  woodland 
regions  in  the  middle  and  southern  parts  of  Europe.  It  flowers 
between  December  and  February,  and  hence  its  name,  — Christmas 
Rose.  It  is  cultivated  in  the  gardens,  chiefly  in  consequence  of  the 
period  of  the  year  at  which  it  flowers.  The  hellebore  of  antiquity 
appears  to  have  been  Helleb'orus  officina'Us.  It  is  usually  imported 
into  England  from  Hamburg,  but  sometimes  from  Marseilles. 
(Pereira.) 

Black  hellebore  root  consists  of  a black  root  stock,  and  numerous 
fibres  or  radicles,  which  are  of  a brownish  black  colour  externally, 
whitish  or  yellowish  within,  and  of  about  the  thickness  of  a straw. 
The  smell  is  feeble,  and  like  that  of  senega  root ; and  the  taste  slight 
at  first,  and  afterwards  bitterish,  nauseous  and  acrid  ; but,  as  met 
with  in  the  shops,  it  does  not  exhibit  much  acridity.  The  active 
properties  would  seem  to  be  dependent  upon  an  acrid  oil.  They 
are  extracted  by  both  water  and  alcohol. 

Black  hellebore,  in  over  doses,  is  an  acro-narcotic  poison.  In 
medicinal  doses,  it  is  emetic  and  cathartic ; but,  although  much  used 
by  the  ancients  in  head  affections,  and  especially  in  insanity,  it  is 
now  never  given  as  a simple  cathartic  or  emeto-cathartic.  Many, 
however,  of  the  present  day,  have  great  confidence  in  its  emmena- 
gogue  virtues,  which  some  have  ascribed  to  its  possessing  a specific 
action  on  the  uterus ; but  the  majority,  with  more  propriety,  refer  its 
action  on  that  organ  to  its  effect  upon  the  intestinal  canal.  Dr. 
Mead  believed  it  to  be  superior  to  any  other  emmenagogue. 

The  dose  of  the  powdered  root,  as  an  emmenagogue,  is  from 
gr.  V to  gr.  X,  or  more,  according  to  the  effects. 

TINCTU'RA  HELLEB'ORI,  TINCTURE  OF  BLACK  HEL  LEBORE.  {Hellebor.  contus. 
§iv  ; Alcohol,  diliit.  Oij  ; prepared  either  by  maceration  or  dis- 
placement.) The  dose  of  this  preparation  is  from  f.  gss  to  f. 

EXTRAC'TUM  HELLEB'ORl,  EXTRACT  OP  BLACK  HEL'LEBORE.  (Made,  by  the 
process  of  displacement,  from  black  hellebore  in  coarse  powder.) 
This  preparation,  which  is  not  officinal  in  any  of  the  British  Phar- 
macopoeias, purges  drastically  in  the  dose  of  twelve  or  fifteen  grains. 
It  is  rarely  or  never  employed  as  an  emmenagogue. 

Bacher^s  Pills,  formed  of  this  extract  and  myrrh,  each  §i ; pow- 
dered leaves  of  carduus  benedictus  ^iij, — -were  introduced  into  the 
French  codex  under  the  name  Pilules  ex  Helleboro  et  Myrrhd,  and 
had  a high  reputation  as  an  emmenagogue ; but  they  are  not  much, 
if  at  all,  used. 

II.  Excitant  Emmenagogues. 

As  the  condition  of  amenorrhoea  is  so  often  dependent  upon  an 
asthenic  condition  of  the  system,  a multitude  of  excitants  have  been 
employed,  including  almost  all  those,  that  are  usually  regarded  as 
antispasmodics;  the  following  have,  however,  been  held  in  highest 
repute  by  different  therapeutists. 


412 


fjPECIAL  EMMENAGOGUES. 


3.  ASSAFGE'TIDA.  — ASSAFET'IDA. 

It  has  been  long  maintained,  that  assafetida  has  a specific  action 
on  the  uterus,  and  the  results  of  various  observers  appeared  to  show, 
that  it  was  capable  of  bringing  on  the  menstrual  discharge  sooner 
than  usual,  (Jorg)  ; but  if  it  be  admitted,  that  such  is  the  result  of 
the  use  of  assafetida  in  health  — for  the  experiments  were  made 
on  healthy  individuals  — it  is  by  no  means  admitted,  that  the  same 
result  would  follow  in  disease ; and  accordingly  assafetida  is  now 
rarely  or  never  employed  in  amenorrhoea,  and  the  same  may  be 
said  of 


4.  CASTO'REUM.  — CASTOR  ; and 

5.  GAL'BAKUM, 

which  were  used  as  emmenagogues  by  the  ancients ; and  are 
still  occasionally  employed,  but  not  in  this  country,  in  affections, 
that  are  complicated  with  obstruction  of  the  catamenia. 

6.  HEDEO'MA.  — PEN'NYROYAL. 

This  herb  — as  stated  under  Excitants  — is  indebted  for  its  pro- 
perties to  the  essential  oil  which  it  contains.  It  is  a popular  em- 
menagogue,  but  is  rarely  prescribed  by  the  physician.  It  is  usually 
given  copiously  in  the  form  of  hot  Pennyroyal  tea  ; the  feet  being, 
at  the  same  time,  placed  in  warm  water ; or  in  a mustard  pedilu- 
vium. 

European  Pennyroyal  — Mentha  Pule'gium  — is  considered  to  pos- 
sess the  same  properties,  and  is  used  as  a domestic  remedy  by  Eu- 
ropean females. 

7.  JUNIP'ERUS  VIRGINIA'NA.  — RED  CEDAR. 

This  evergreen.  Sex.  Sxst.  Dioecia  Monadelphia  ; Nat.  Ord. 
Coniferse,  grows  in  every  part  of  the  Union.  The  leaves  are  in  the 
secondary  list  of  the  Pharmacopoeia  of  the  United  States.  They 
have  a strong  characteristic  odour  ; and  an  aromatic  bitterish  taste. 
The  esential  properties  reside  in  volatile  oil ; and,  besides,  tannin 
exists  in  them. 

The  medical  virtues  of  juniperus  virginiana  are  analogous  to  those 
of  savine,  but  less  in  degree.  It  is,  indeed,  frequently  known 
throughout  the  country  by  the  name  of  Savine.  (Prof.  Bigelow.) 
It  may  be  given  as  an  emmenagogue,  in  infusion,  {Junip.  Virgi- 
nian. 5ij  ; AqacB^  Oss.  Dose,  f.  §iss  to  f.  §iij  ;)  but  it  is  not  often 
prescribed. 

8.  SABPJVA.  — SAVINE. 

Savine  is  the  tops  of  Junip'erus  sahi'na  or  common  savine^  which 
is  a native  of  the  south  of  Europe,  and  of  Asiatic  Russia,  but  thrives 
under  cultivation  in  Great  Britain.  It  is  said  also  to  grow  wild  in 
the  neighbourhood  of  the  northwestern  lakes.  The  tops  have  a 
strong  characteristic  smell,  especially  when  bruised  ; and  a disagree- 


SABINA.  413 

able,  bitter,  acrid  taste  ; and  these  properties  are  retained,  to  a cer- 
tain extent,  when  the  tops  are  dried. 

The  medical  properties  of  savine,  are  chiefly  dependent  upon  an 
essential  oil,  which  is  officinal ; and  they  are  yielded  to  water, 
alcohol,  and  fixed  oils.  The  leaves  have  been  subjected  to  an- 
alysis by  Mr.  C.  H.  Needles,  and  have  yielded  the  following  con- 
stituents— gum,  tannin,  resin,  chlorophylle,  fixed  oil,  volatile  oil, 
salts  of  potassa,  lime,  and  bitter  extractive. 

Savine,  in  large  doses,  is  an  acrid  poison,  inducing  vomiting,  purg- 
ing, and  every  sign  of  violent  inflammation  of  the  lining  membrane 
of  the  stomach  and  intestines.  In  one  case,  in  which  the  oil  had 
been  given  with  the  view  of  inducing  abortion,  it  caused  violent  ne- 
phritis. It  is  by  reason  of  its  powerful  action  on  the  system  of  the 
mother,  that  it  is  sometimes  effective  in  separating  the  connexion 
between  her  and  the  foetus,  and  thus  occasioning  the  expulsion  of 
the  latter.  Fatal  cases  are,  indeed,  recorded,  where  it  had  been 
given  asi  an  emmenagogue.  Dr.  Francis  Home,  of  Edinburgh, 
highly  extolled  it  in  amenorrhoea  dependent  upon  torpor  of  the 
uterus ; but  it  has  not  been  much  used  of  late,  in  consequence  of 
the  uncertainty,  and  at  times  the  severity,  of  its  operation.  Dr. 
Pereira  has  affirmed  — as  the  result  of  his  own  observation  — that  it  is 
the  most  certain  and  most  powerful  emmenagogue  of  the  materia 
medica ; that  he  has  employed  it  in  numerous  cases,  and  has  never 
seen  any  ill  effects  from  its  administration. 

The  dose  of  the  powder  is  from  gr.  v to  gr.  xv,  repeated  three  or 
four  times  a day.  It  may,  likewise,  be  given  in  infusion,  {Sabin. 
gj  ; Aquce  bullient.  Oss.  Dose,  one  or  two  table-spoonfuls.) 

O'LEUM  SABI'NjE,  OIL  OF  SAVINE.  This  oil  is  obtained  from  savine  by 
distillation.  It  has  the  odour  of  the  plant  ; and  an  exceedingly  acrid 
bitter  taste.  It  is  used  in  the  same  cases  as  the  savine  itself,  and 
is  the  preparation  generally  employed  when  the  object  is  to  induce 
abortion.  This  it  accomplishes  by  the  violence  it  does  to  the  system 
of  the  mother,  inducing  gastro-enteritis,  and  nephritis,  and  occasion- 
ally death.  As  an  emmenagogue,  the  dose  is  from  two  to  six  drops, 
made  into  a mixture  with  sugar  or  mucilage.  Dr.  Pereira  regards 
the  oil  as  by  far  the  most  convenient  and  certain  preparation  of  sa-^ 
vine,  and  it  is  the  one  which  he  always  employs. 

9.  RUTA.  — RUE. 

Rue  is  the  root  of  Ruta  Grav'eolens,  Common  or  Garden  Rue ; 
Sex.  Syst.  Decandria  Monogynia,  Nat.  Ord.  Rutaceee  ; a perennial 
plant,  which  is  indigenous  in  the  south  of  Europe  and  the  Levant ; 
and  is  often  cultivated  in  the  gardens  of  this  country.  It  flowers  from 
June  to  September.  The  leaves  are  officinal  in  the  secondary  list 
of  the  Pharmacopoeia  of  the  United  States. 

The  herb  has  a strong  disagreeable  odour,  which  is  dependent 
upon  a volatile  oil,  obtainable  by  distillation,  — the  Oleum  Ruta: 
35* 


414  SPECIAL  EMMENAGOGUES. 

of  the  Dublin  and  Edinburgh  Pharmacopoeias.  It  contains,  also, 
bitter  extractive.  The  taste  of  the  leaves 
is  bitter  and  acrid  ; and  when  fresh,  they  irri- 
tate the  skin,  and,  at  times,  even  excite  vesi- 
cation. They  yield  their  virtues  to  hot  water. 

From  what  has  been  said,  it  is  obvious, 
that  rue  is  a powerful  excitant ; hence,  and 
as  it  makes  also  a powerful  impression  on  the 
nerves  of . gustation  and  olfaction,  it  proves 
antispasmodic,  and  is  frequently  used  as  a 
domestic  remedy  in  hysteric  and  other  ner- 
vous affections.  It  is  not  often  prescribed, 
however,  by  the  physician,  as  an  antispas- 
modic. Amongst  the  laity ^ it  has  great  reputa- 
tion as  as  an  emmenagogue  ; and  some  practi- 
tioners have  believed  it  to  be  not  only  as  use- 
ful in  catamenial  obstructions  as  other  more 
esteemed  emmenagogues,  but  have  thought 
its  action  to  be  so  peculiarly  directed  to  the 
uterus  as  to  be  capable  of  inducing  menorrha- 
gia, abortion  and  inflammation.  (Christison.) 
It  is  rarely,  however,  used  by  the  profession 
as  an  emmenagogue. 

The  dose  of  the  powder  is  from  fifteen  to 
thirty  grains,  two  or  three  times  a day ; but  it 
must  be  given  with  caution,  as  there  is  some  rea- 
son to  believe  it  to  be  an  acro-narcotic  poison. 

It  is  more  commonly  given  in  infusion — Rue  Tea  [Rutce^  ; 
Aquce  hullient.  Oj.  Dose,  f.  §iss  to  f.  §ij.) 

Oil  of  rue  is  sometimes  prescribed  in  the  dose  of  two  to  six  drops 
in  sugared  water. 

10.  RU'BIA.— MADDER. 

Madder  is  the  root  of  Ru'bia  Tincto'rum,  Dyeo'^s  Madder;  Sex, 
Syst.  Tetrandria  Monogynia  ; Nat.  Ord.  Rubiacese ; a native  of  the 
south  of  Europe  and  the  Levant,  which  is  cultivated  in  various 
parts  of  the  continent  of  Europe  ; and  is  exported  largely  from  the 
Levant,  Holland,  and  the  south  of  Europe.  It  contains  a variety  of 
colouring  matters — the  most  important  of  which  is  the  madder-red 
or  Alizarin.  (Pereira.)  The  root  — which  is  officinal  in  the 
secondary  list  of  the  Pharmacopoeia  of  the  United  States — is  long, 
cylindrical,  of  about  the  thickness  of  a writing-quill,  and  a deep, 
reddish-brown  colour  externally.  The  woody  meditullium  is  yellow 
when  fresh,  but  becomes  reddish  by  drying.  The  odour  of  the  root 
is  weak  and  peculiar  ; the  taste  bitter  and  astringent. 

Madder  has  been  considered  by  some  to  be  possessed  of  emmena- 
gogue virtues  ; and  Professor  F.  Home,  of  Edinburgh,  believed  it 
to  be  the  strongest  and  safest  emmenagogue  known.  It  may  be 


Fig.  59. 


Ruta  graveolens. 


ELECTRICITAS. 


415 


of  service,  when  tonic  emmenagogues  are  indicated,  but  it  has  not 
the  confidence  of  physicians,  and  is,  therefore,  scarcely  ever  used. 
Its  remarkable  property  of  colouring  the  bones  of  animals  fed  on 
it  red  is  well  known. 

The  dose  of  madder  may  be  half  a drachm,  repeated  three  or  four 
times  a day. 

11.  TANACE'TUM.— TANSY. 

Tansy — whose  general  properties  are  described  under  Anthel- 
mintics (p.  215)  — has  been  much  used  in  domestic  practice  in  ute- 
rine affections.  It  has  borne  the  reputation  of  an  emmenagogue; 
and,  by  virtue  of  its  bitter  principle,  and  essential  oil,  it  may  act  as 
such  in  cases  w^here  the  excitant  emmenagogues  are  indicated.  In 
popular  practice,  it  is  supposed  even  to  arrest  uterine  hemorrhage ; 
and,  in  the  Southern  states,  the  author  has  known  a bag  of  tansy 
placed  over  the  abdomen  restrain  the  flow.  It  is  scarcely  ever 
prescribed  by  the  regular  practitioner. 

12.  ELECTRIC"ITAS.  — ELECTRIC"ITY. 

The  excitant  influence  of  electricity  (see  Excitants)  can  be  made 
to  bear  immediately  upon  the  uterus,  when,  from  the  attending  phe- 
nomena, there  is  reason  to  believe  that  amenorrhoea  is  dependent 
upon  torpor  of  that  organ. 

The  practitioner  has  it  in  his  power  to  graduate  the  amount  of  ex- 
citation. Thus,  where  a gentle  stimulation  is  needed,  it  may  be 
sufficient  to  insulate  the  individual,  and  to  draw  electricity  from  the 
pelvic  region  in  the  form  of  the  electric  pencil  ; where  a greater  de- 
gree is  needed,  by  sparks  ; and  where  a still  greater,  to  make  the 
uterus  a part  of  the  electric  circuit,  and  to  discharge  a Leyden  jar 
through  it  — graduating  properly  the  extent  of  the  discharge  accord- 
ing to  the  demands  of  the  case. 

Or,  Galvan'ic  Electric"ity  may  be  substituted,  or  the  shocks 
produced  by  interrupted  currents,  as  by  the  elec'tro-magnet'ic  ap- 
para'tus. 


Such  are  the  prominent  articles  that  have  been  used  as  emmena- 
gogues. Besides  them,  however,  others  have  been  proposed  by  dif- 
ferent observers.  A recent  writer.  Dr.  Churchill,  expresses  the 
opinion,  that  Iodine,  Ergot  and  Strychnia,  are  the  least  doubtful 
in  regard  to  their  power  of  acting  on  the  uterus.  The  iodine  may 
be  given  in  the  form  of  Tinclura  lodini  composita,  (q.  v.),  the  dose 
of  which  may  be  gtt.  x to  gtt.  xxx,  three  times  a day.  Ergot  may 
be  prescribed  in  powder,  gr.  v — x,  two  or  three  times  a day,  and 
strychnia,  in  the  form  of  tincture,  (p.  384,)  from  six  to  twenty-four 
drops,  twice  or  thrice  a day.  It  is  very  doubtful,  however,  whether 
any  of  these  agents  be  entitled  to  any  reputation  ; indeed,  they  have 
been  classed,  along  with  others,  by  a recent  respectable  writer,  Dr. 
Ferguson,  as  nostrums,  ‘‘  There  are  numberless  nostrums”  — he 


416 


PARTURIFACIENTS. 


remarks  — of  greater  or  less  value,  which,  from  their  very  num- 
ber, prove  how  capricious  a disease  is  amenorrhoea,  and  how  curable. 
Dale  excites  the  mammae  by  repeated  application  of  one  or  two 
leeches ; the  organ  enlarges  greatly,  and  the  uterus  sympathises  on 
being  thus  aroused.  Very  many  authors  give  five  to  eight  grains  of 
ergot.  Carron  du  Villard  recommends  cyanuret  of  gold  in  minute 
doses  ; Bradley  gives  strychnine ; Brera,  iodine ; Amussat  applies 
an  exhausted  glass  to  the  uterus,  and  Rostan,  leeches.” 

The  tincture  of  guaiacum,  so  highly  extolled  by  Dr.  Dewees  as  ^ 
specific  in  amenorrhcea  and  dysmenorrhcea,  might  be  classed  in 
same  category. 


II.  PARTURIFA'CIENTS. 

Srifoiv.  Parhirifacientia,  Parturientia^  Mortiva,  Amblotica,  Phthoria,  Apophtho- 
ria,  Ectrotica,  Ecbolica,  Abortives,  Parturients,  Ecbolics. 

Definition  of  parturients  — Most  of  them  indirect  agents — Often  destroy  the  mother  — 
Aristolochics  — Special  parturients. 

What  has  been  said  of  emmenagogues  might,  perhaps,  be  extend- 
ed to  theMivision  of  parturifacients  or  abortives,  which  have  been  de- 
fined by  Dr.  Eberle  — “substances  that  promote  the  parturient  en- 
ergy.” Certain  it  is,  that  fifty  years  ago,  no  man  of  science,  in 
this  country,  would  have  asserted  that  we  are  possessed  of  any 
agent  that  acts  by  virtue  of  specific  powers  over  the  uterine  fibres. 
Since  that  period,  however,  such  an  agent  — ergot  — has  been 
brought  to  the  notice  of  the  profession,  and  has  received  so  many 
testimonials  in  its  favour  as  to  cause  its  admission  into  every 
work  on  Materia  Medica.  In  no  country  has  this  substance  been 
more  employed  than  in  the  United  States,  and  in  no  country  has 
it  so  many  supporters.  Yet  there  are  many,  who,  from  their  expe- 
rience, are  not  satisfied  that  it  exerts  the  power  over  the  gravid 
uterus  that  has  been  ascribed  to  it.  It  must  be  admitted,  that  no 
cases  could  present  themselves,  in  which  it  is  more  difficult  to  trace 
accurately  the  relation  between  cause  and  effect.  Every  one,  who 
has  practised  extensively  in  obstetrics,  must  have  observed,  that  the 
parturient  efforts  occasionally  flag,  and  indeed  are  wholly  suspended, 
yet  they  recur,  and  the  labour  proceeds  rapidly  to  a favourable  ter- 
mination. Now,  if  in  any  such  case,  a remedy,  presumed  to  be 
parturient,  were  administered  during  the  period  of  the  cessation  of 
pain,  the  recurrence  of  the  pain  in  this  sudden  manner,  could  hardly 
fail  to  be  ascribed  to  the  antecedent  — the  administration  of  the 
presumed  parturient.  Let  the  obstetrical  practitioner,  who  has  never 
had  recourse  to  any  such  agent,  call  to  mind,  how  few  the  cases  are, 
in  which  delivery  has  had  to  be  assisted,  in  consequence  of  the  total 
cessation  of  the  pains,  and  how  common  it  is  to  meet  with  a partial 


ERGOTA.  417 

or  temporary  cessation  ; and  he  will  see,  that  the  absolute  necessity 
for  the  use  of  a parturifacient  is  not  a common  occurrence. 

But,  if  hesitation  be  indulged  in  regard  to  the  possession  by  the 
ergot  of  any  specific  powers  over  the  uterus,  there  can  be  none  as 
respects  the  other  substances,  that  have  been  employed  as  parturients. 
All  these  are  indirect  agents,  and  act  only  upon  the  ovum  through 
the  mother,  endangering  her  life,  as  well  as  that  of  her  infant.  The 
remark  of  the  poet  of  antiquity,  that  “ she  who  destroys  her  off- 
spring in  utero^  often  perishes  — [scepe  suos  utero  quce  necat^  ipsa 
perit^^’’)  — is  admitted  to  be  correct  by  all  writers  on  medical  juris- 
prudence, and  by  every  one  who  has  at  all  investigated  the  subject. 
The  drugs  and  agencies  employed  with  the  view  of  inducing  abor- 
tion are  of  the  most  powerful  kind,  — emetics,  purgatives,  acro-nar- 
cotic  poisons,  mercury,  &c.  Bleeding,  too,  has  often  been  practised 
with  this  intent,  but  it  has  rarely  or  never  been  successful. 

aristoloch'ics. 

The  German  writers  admit  a class  or  agents  which  pro- 

mote the  lochial  secretion,  (Conradi)  ; but  it  need  scarcely  be  said,  that 
there  are  no  such  direct  agents,  and  that  the  pathological  cause  of  the 
suppression  or  diminution  of  the  discharge  must  always  be  appreciated 
and  combated.  Warm  fomentations  over  the  uterine  region,  warm 
injections  into  the  vagina  and  rectum,  leeches  to  the  labia  pudendi 
or  to  the  inside  of  the  thighs,  are  amongst  the  topical  remedies 
which  are  employed  to  solicit  blood  towards  the  uterine  region  ; but 
these  agents  cannot  be  proper  in  all  cases,  and  their  employment 
must  be  regulated  by  general  principles. 


SPECIAL  PARTURIFACIENTS. 

1.  ER'GOTA.  — ERGOT. 

Ergot ^ SecaT  cornu' tum^  or  Spurred  rye^  from  French,  ergot ^ ‘a 
spur,’  is  generally  considered  to  be  the  result  of  a disease  in  rye, 
occurring  most  frequently  when  a hot  summer  succeeds  a wet 
spring. 

For  the  various  opinions  that  have  been  entertained  in  regard 
to  ergot,  the  reader  is  referred  to  another  work,  {JVew  Remedies^ 
4th  edit.  p.  248,  Philad.  1843.)  It  maybe  sufficient  to  state,  that  the 
diseased  state  of  the  grain  is  occasioned  by  the  growth  of  a fungus 
not  previously  detected,  and  to  which  has  been  given  the  name 
Ergotx'tia  ahortans  or  E.  ahortifa'ciens. 

Ergot  consists  of  grains  from  a third  of  an  inch  to  an  inch  and 


418 


PARTURIFACIENTS. 


Fig.  60. 


a half  long, and  from  aline  to  threelines  in  diameter,  usually  curved  like 

the  spur  of  acock,  whence  the  name, 
— having  commonly  two  longitudinal 
furrows,  and  being  often  irregularly 
cracked  and  fissured.  Externally,  it 
is  of  a dingy  purple  hue,  but  inter- 
nally of  a pale  grayish  red,  or  gray- 
ish white.  Its  odour  is  peculiar, 
fishy  and  nauseous  ; taste  obscurely 
acrid  and  disagreeable.  Unless  kept 
excluded  from  the  air,  it  swells  and 
softens,  acquiring  a deep  black  co- 
lour, and  heavy  smell,  and  becoming 
infested  by  a little  acarus,  which  is 
about  one  fourth  the  size  of  the  mite 
of  cheese,  and  destroys  the  interior  of 
the  ergot,  leaving  the  grain  as  a mere 
shell.  In  four  months,  according  to 
Dr.  Pereira,  seven  and  a half  ounces  of 
fsecal  matter  of  the  acarus  were  formed 
from  seven  pounds  of  ergot.  The 
powder  becomes  quickly  damp,  and 
full  of  animalcules.  The  ergot  should 
therefore  be  fresh  ; certainly  it  ought 
not  to  be  kept  for  more  than  two 
years.  It  is  affirmed,  that  a small 
piece  of  camphor  kept  in  the  stoppered 
bottle,  which  contains  the  ergot,  soon 
annihilates  the  whole  race  of  insects, 
and  prevents  any  fresh  formation. 

When  ergot  is  examined  with  the 
microscope,  its  internal  structure  is 
found  to  consist  of  minute  roundish 
cells,  many  of  which  contain  particles 
of  oil ; and  the  bloom  seen,  at  times, 
on  its  surface,  appears  to  be  composed 
of  the  sporidia  of  the  fungus  to  which 
it  is  believed , by  many,  to  owe  its  origin. 
Various  analyses  have  been  made  of  ergot  by  Vauquelin,  Maas, 
Bonvoisin,  Pettenkofer,  Winkler,  Robert,  Wiggers,  and  Wright. 
The  analysis  of  the  last  gentleman  is  considered  to  be  the  most 
accurate.  He  found  it  to  consist,  in  100  parts ; — of  thick  white 
oil,  31.00  ; osmazome,  5.50  ; mucilage,  9.00  ; gluten,  7.00  ; fungin, 
11.40;  colouring  matter,  3.50;  fecula,  26.00;  salts,  3.10;  loss, 
3.50.  Dr.  Wright  considers  it  to  differ  from  sound  rye,  chiefly  in 
the  presence  of  oil,  osmazome,  anc\  fungin. 

Ether  and  the  volatile  oils  remove  its  active  part.  It  would  ap- 
pear, however,  that  its  activity  resides  in  the  fixed  oil,  — Oil  of 


Secdle  cornutum. 


ERGOTA. 


419 


Ergot  — which  may  be  readily  obtained  from  the  powder  by  agi* 
tation  with  sulphuric  ether,  and  expulsion  of  the  ether  by  spon- 
taneous evaporation. 

As  it  is  important  to  judge  between  a good  and  a bad  specimen 
of  ergot,  Dr.  Wright  states,  that  if  it  be  clear  and  smooth  on  its 
surface,  not  powdery  ; of  a deep  purple  colour ; neither  entirely 
black  nor  light  brown ; have  a full  strong  odour ; break  clearly, 
exhibiting  a pink  blush  internally  ; be  unpunctured  by  insects  ; 
burn  with  a clear  jetting  flame,  and  be  of  a less  specific  gravity 
than  water,  its  activity  may  be  trusted. 

The  effects  produced  by  ergot,  when  eaten  as  food,  are  referred  to 
elsewhere  ; as  well  as  the  sedative  influence,  which  it  is  capable  of 
exerting  in  various  diseases.  The  extraordinary  property  ascribed 
to  it  of  assisting  the  parturient  efforts  alone  falls  under  consideration 
here.  This  has  been  long  credited  in  Germany ; as  the  old  German 
names  Mutterkorn  ‘‘  womb  grain,”  and  Geburpulver^  ‘‘  parturient 
powder,”  and  the  Pulvis  Parturieniis  of  the  Marburg  Pharmacopoeia 
sufficiently  testify. 

Between  thirty  and  forty  years  ago,  it  was  recommended  in  this 
country  by  Dr.  Stearns,  of  Saratoga  county.  New  York,  and  since 
that  time,  an  immense  mass  of  evidence  has  been  adduced  in  its 
favour.  Still,  there  are  many  who  deny  it  all  power  over  the  uterus, 
both  in  the  unimpregnated  and  the  impregnated  state,  and  who  affirm, 
that  it  acts  only  indirectly  on  that  viscus  through  the  general  disturb- 
ance it  occasions.  Such  is  the  opinion  of  a modern  experimenter,  Dr. 
Jorg,  who  affirms,  as  the  result  of  his  experiments  and  observations, 
that  “ there  is  no  further  connexion  between  these  degenerate  grains 
and  the  uterus,  than  the  word  mutter  uterus,’)  which  is  common  to 
both.”  From  his  various  experiments.  Dr.  Jorg  infers,  that  ergot, 
when  taken  in  small  doses,  produces  little  or  no  effect  upon  the 
functions,  but  when  fresh  dried  in  an  oven,  and  given  in  large  doses, 
it  oppresses  the  stomach,  occasioning  nausea,  vomiting,  colic,  and 
liquid  evacuations  ; destroys  the  appetite,  and  injures  the  digestive 
powers  ; these  effects  being  accompanied  by  a sense  of  weight  in  the 
head,  vertigo,  headache,  and  general  torpor  of  the  system.  Under 
these  circumstances,  he  thinks  it  not  difficult  to  understand,  that  the 
connexion  between  the  foetus  and  the  uterus  may  be  modified,  and 
that  abortion  may  ensue.  But  although,  as  elsewhere  shown,  ergot 
is  capable  of  producing  acro-narcotic  effects,  their  supervention  is 
not  desired  by  those,  who  regard  it  to  be  possessed  of  peculiar 
powers  by  which  it  causes  contraction  of  the  uterine  fibres  of  the 
parturient  female,  and  who  administer  it  with  that  view.  When 
given  in  appropriate  doses,  the  parturient  efforts  become  more  forcible, 
constant,  and  almost  unremitting ; but  there  is  no  bodily  disorder. 

It  has  been  very  freely  administered  in  this  country,  as  well  as  in 
others,  and  it  can  scarcely  be  doubted,  that  although,  in  many  cases, 
the  uterine  efforts  might  have  returned,  and  probably  did  return, 
independently  of  it,  — in  the  remainder  the  ergot  must  have  exerted 
a special  action  on  that  viscus.  From  the  results,  therefore,  of  such 


420 


SPECIAL  PARTURIFACIENTS. 


cases,  we  seem  to  be  compelled  to  admit,  that  ergot  is  possessed  of 
ecbolic  properties  by  which  it  acts  upon  the  parturient  uterus ; but 
that  it  is  capable  of  producing  any  effect  upon  the  unimpregnated 
organ,  or  upon  the  impregnated  at  any  time  except  when  parturition 
has  commenced,  is  denied  by  most  observers.  The  experiments, 
indeed,  of  Drs.  T.  Wright  and  De  Gravina,  exhibit  the  singular  fact, 
that  it  appears  to  have  the  power  of  prolonging  gestation  in  the 
guinea-pig  and  rabbit,  when  administered  for  a considerable  period. 

The  cases,  in  which  ergot  may  be  given  with  propriety,  are  those 
in  which  there  is  insufficiency  of  uterine  effort,  either  in  force  or 
frequency,  or  both,  — when  the  labour  is  somewhat  advanced,  and 
the  os  uteri  moderately  dilated  ; and  when  there  is  no  mechanical 
obstacle  to  delivery,  owing  to  deformity  of  the  pelvis,  rigidity  of  the 
os  uteri,  or  preternatural  presentation.  It  should,  likewise,  be  used 
with  more  caution  in  first  pregnancies.  It  is  chiefly  employed  to 
increase  the  expulsive  efforts  in  lingering  labours,  — to  hasten  de- 
livery on  the  occurrence  of  alarming  symptoms  ; to  expedite  the  ex- 
pulsion of  the  placenta,  when  the  uterine  efforts  fail ; to  facilitate  the 
discharge  of  clots,  hydatids,  &c.;  to  restrain  uterine  hemorrhage, 
especially  when  occurring  in  the  puerperal  or  gravid  state  ; to  facili- 
tate abortion,  when  it  has  once  commenced  ; and  it  has  been  strongly 
recommended  for  the  prevention  of  uterine  hemorrhage.  In  all  these 
cases,  the  good  effects  result  from  the  specific  action  of  the  drug  on 
the  uterus  in  action. 

It  has  been  an  objection,  often  urged  against  ergot,  that  the 
number  of  still-born  has  been  augmented  since  its  introduction  ; and 
that  observation  has  shown,  that  whenever  it  is  given  to  expedite 
delivery,  more  or  less  danger  always  accrues  to  the  offspring,  either 
by  the  induction  of  asphyxia,  or  of  positive  death,  owing  to  the  vio- 
lence of  the  uterine  contractions,  or  to  its  deleterious  agency  on  the 
foetus.  It  would  not  seem,  however,  that  when  it  is  prudently  ad- 
ministered, there  is  sufficient  reason  for  the  belief,  that  it  is  injurious 
to  the  child. 

It  has  been  already  remarked,  that  ergot  exerts  its  properties  on 
the  uterus  in  action.  Such  is  the  general  opinion  ; but  there  are 
some  who  think,  that  it  is  capable  of  originating  uterine  action,  and 
of  inducing  premature  labour  at  any  period  of  utero-gestation  ; whilst 
others  are  disposed  to  think,  that  the  ecbolic  properties  of  the  drug 
are  not  exerted  upon  the  impregnated  uterus  at  an  early  period  of 
utero-gestation  ; but  that  at  a certain  stage  of  development,  the 
uterine  fibres  are  capable  of  being  excited  by  it,  so  as  to  expel  the 
foetus.  It  would  be  strange,  however,  were  its  agency  to  be  thus 
restricted. 

A few  cases  of  apparently  good  effects  in  amenorrhoea  have  been 
published  ; few,  however,  if  any,  believe  it  to  be  possessed  of  em- 
menagogue  virtues. 

Ergot  may  be  given  in  the  form  of  the  fresh  powder,  in  the  dose 
of  ten  to  twenty  grains  in  sugared  water,  and  be  repealed  every 


ERGOT A. 


421 


twenty  minutes,  until  the  effect  upon  the  uterus  is  elicited.  Von 
Busch  found  the  best  results  when  it  was  given  in  the  dose  of  ten 
grains  every  ten  or  fifteen  minutes.  In  one  case,  it  was  requisite  to 
repeat  it  eight  times  ; in  four  cases,  six  times  ; in  twelve,  five  ; in 
thirty-three,  four  ; and  in  the  remainder  of  one  hundred  and  seventy- 
five  cases,  three  and  less ; the  smallest  quantity  exhibited  was  a 
single  dose  of  ten  grains. 

The  action  of  ergot  on  the  uterus  commences  in  some  cases 
as  early  as  seven  minutes  after  its  exhibition,  whilst  in  others  a much 
longer  period  is  required.  The  average  time  appears  to  be  about 
ten  or  fifteen  minutes.  Dr.  Samuel  Hardy,  of  Dublin,  considers, 
that  it  has  always  commenced  within  25  minutes  at  the  furthest, 
when  the  child  has  been  expelled  alive  ; that  if  a longer  time 
than  this  has  elapsed,  instruments  have  been  necessary,  and  the 
child  has  been  born  dead.  The  beneficial  effect  of  ergot  is  evi- 
denced by  the  pains  running  into  one  another  without  any  apprecia- 
ble interval. 

In  regard  to  the  most  advisable  forms  of  preparation  of  er- 
got, such  a difference  of  sentiment  exists  as  to  throw  obscurity  on 
the  subject.  Dr.  Wright — it  has  been  seen  — regards  the  fixed 
oil,  left  after  the  evaporation  of  ether,  in  which  ergot  has  been 
digested,  to  be  the  active  matter:  and  he  states,  as  the  result  of 
positive  experiment,  that  it  has  the  same  affect  in  inducing  power- 
ful uterine  contractions  as  ergot  itself ; for  which  purpose,  it  is 
given  in  the  dose  of  twenty  to  fifty  drops,  in  tea,  weak  spirit  and 
water,  some  aromatic  water,  or  made  into  an  emulsion  with  muci- 
lage and  syrup.  This  would  seem  to  be  the  most  advisable  form 
of  exhibition,  inasmuch  as  the  oil  retains  its  properties  for  several 
years,  if  kept  in  well  closed  bottles  excluded  from  light. 

Frequently,  however,  ergot  is  given,  by  preference,  in  infusion; 
but  it  is  not  easy  to  see  how  the  fixed  oil  can  be  taken  up  by 
hot  water.  Professor  Hooker,  of  New  Haven,  who  is  of  opinion 
that  the  parturifacient  and  the  narcotic  properties  may  be  separated, 
recommends  the  clear  infusion,  which  possesses,  he  conceives,  the 
former  property  only.  The  powder,  of  course,  must  contain  both. 
Dr.  Hooker  found,  that  when  a quantity  of  pulverised  ergot  was 
macerated  for  several  days  in  sulphuric  ether,  and  the  liquid  was 
evaporated  in  a glass  vessel,  until  it  no  longer  afforded  the  smell  of 
ether,  there  remained,  at  the  bottom  of  the  vessel,  a small  quantity 
of  thick  heavy  oil,  resembling,  in  appearance,  fish  oil ; above  this 
was  a lighter  oil,  much  more  abundant  than  the  former,  of  a light 
reddish-brown  colour,  and  of  a sweetish  nauseous  taste.  This  light 
oil  was  found  to  be  possessed  of  decidedly  narcotic  properties ; and 
similar  effects  resulted  from  its  employment,  in  some  experiments 
made  with  it  at  the  suggestion  of  the  author  by  Dr.  McKee,  of 
South  Carolina,  at  the  time  resident  physician  in  the  Philadelphia 
Hospital. 

On  the  other  hand,  Mr.  Lever  prepared  an  ethereal  tincture  of 
VOL.  I. — 36 


422 


SPECIAL  PARTURIFACIENTS. 


ergot,  by  digesting  four  ounces  of  it  in  four  fluid  ounces  of  ether,  for 
several  days.  This  was  poured  ofl',  evaporated  to  dryness,  and  the 
residue  again  dissolved  in  two  fluid  ounces  of  ether  : of  this  solu- 
tion, from  n^xv  to  tr^xxx,  were  given  for  a dose.  It  was  found  to  act 
])owerfully  on  the  uterus  as  a parturifacient;  and  Mr.  Lever  remarks, 
that  whilst  all  the  other  preparations  of  ergot  not  unfrequently  induce 
acro-narcosis,  he  has  not  once  observed  those  eflects  from  the  use  of 
the  ethereal  solution  oj  ergot,  — and  he  therefore  thinks,  that  the 
acro-narcosis  is  caused  by  some  constituent  of  the  drug,  which  ether 
does  not  dissolve, — a view,  which  is  wholly  irreconcilable  with 
the  results  of  Professor  Hooker’s  observations.  The  latter  gentle- 
man, in  his  experiments,  employed  a lighter  portion  of  the  oil  of  ergot 
of  Dr.  Wright : Mr.  Lever’s  preparation  was  nothing  more  than  a 
solution  of  the  oil  in  ether. 

When  the  infusion  is  employed,  it  may  be  made  of  one  drachm  of 
to  four  ounces  of  — one-third  being  taken  for  a dose. 
When,  however,  the  object  is  to  induce  premature  labour,  much 
larger  doses  have  been  necessary.  It  has  been  given  until  the 
patient  took  in  one  case  six  drachms,  and  in  another  twelve ; half  a 
drachm  being  taken  every  three  or  four  hours. 

The  plan  adopted  by  Dr.  Hardy  ds  to  infuse  half  a drachm  of  pow- 
dered  ergot  in  three  ounces  of  boiling  water,  and  after  straining  to  add 
ten  or  fifteen  grains  of  fresh  powderwith  a little  sugar.  The  dose  is  re- 
peated in  twenty  minutes,  and  if  the  uterus  does  not  contract  well 
is  given  a third  time. 

As  the  active  properties  appear  to  reside  in  fixed  oil,  the  alco- 
holic tincture  ought  to  be  an  objectionable  preparation  ; and  so  it 
has  been  regarded. 

Occasionally,  ergot  is  given  in  decoction  ; one  drachm  of  er- 
got  bruised  being  boiled  in  six  ounces  of  water  for  ten  minutes  in 
a lightly  covered  vessel,  and  strained.  The  dose  is  one-third  — 
(For  different  forms  of  preparation,  see  the  author’s  JVew  Remedies, 
edit.  cit.  p.  263.) 

VmUM  ER'GOTiE,  WINE  OF  ERGOT.  {Ergot,  contus.  jij  ; Vini,  Oj.) 
This  is  the  only  officinal  preparation  of  Ergot  in  the  Pharmacopoeia 
of  the  United  States.  The  dose  may  be  f.  ^j  — f.  Jij. 

2.  SOD^  BORAS  - BORATE  OF  SODA. 

Many  of  the  German  writers  ascribe  to  borax  a specific  influence 
over  the  uterus  ; by  which  it  is  supposed  to  favour  the  catamenial 
secretion,  the  pains  of  parturition,  and  the  lochial  discharge,  when 
their  failure  is  dependent  upon  inactivity  of  the  organ. 

It  has  been  recommended  strongly  by  an  able  English  writer.  Dr. 
Copland,  in  cases  of  abortion.  “ When  the  embryo  only,”  he  re- 
marks— “ is  expelled,  the  appendages  being  still  retained,  or  when 
the  hemorrhage  is  great,  the  entire  ovum  still  remaining  in  the  uterus, 
the  ergot  of  rye  will  often  prove  of  inestimable  service  ; and  when 


EXCITANTS. 


423 


given  in  the  form  of  decoction  with  as  much  borax  as  will  dissolve, 
will  seldom  disappoint  our  expectations.’’  As  it  is  prescribed,  how- 
ever, by  Dr.  Copland,  alongwith  anunquestionedparturifacient,  doubts 
may  be  entertained  in  regard  to  its  agency  in  these  cases.  Of  its 
effects,  the  author  can  say  nothing  from  his  own  experience.  * It  has 
been  advised  by  one  practitioner.  Dr.  D.  Stahl,  of  Indiana,  in  dys- 
menorrhcea  occurring  in  plethoric  individuals,  after  blood-letting  had 
been  premised.  The  dose  was  nine  grains  every  two  hours  in  flax- 
seed tea,  given  for  two  days  before  the  expected  recurrence  of  the 
catamenia. 


SECTION  VI. 

AGENTS  THAT  AFFECT  VARIOUS  ORGANS. 

I.  EXCPTANTS. 

Srxox.  Stimulants. 


Irritation,  not  debility,  the  great  lethiferous  agent  — Causes  of  death  in  cases  of  exten- 
sive abscess,  phthisis  puhnonalis,  &c.  Debility  in  one  organ  may  suggest  irritation  in 
another  — Cases  of  really  diminished  action  — Division  of  excitants  — Definition  of 
excitants — Carminatives  — Chiefly  derived  from  the  vegetable  kingdom — Simple 
direct  action  of  excitants  — General  effect  of  excitants  — Excitement  and  collapse 
defined  — Excitants  act  also  as  revulsives  — Therapeutical  application  of  excitants 

— In  gastric  and  intestinal  affections  — In  fevers  — In  inflammatory  diseases  — 
Catarrhs  — In  the  neuroses,  hysteria,  epilepsy,  paralysis  — In  topical  inflammation 

— Mental  excitants  — Special  excitants. 

Although  the  doctrine  — that  debility  is  the  cause  of  almost 
every  diseased  action  — is  now  nearly  exploded,  there  can  be  no 
doubt  that,  owing  to  morbific  agencies,  the  vital  manifestations  of 
a part  may  be  enfeebled,  and  that  a plan  of  treatment,  which  will 
arouse  them  to  greater  activity,  may  occasionally  be  required.  Even 
so  late  as  the  time  of  Cullen  it  was  maintained,  that  the  great  indi- 
cation to  be  followed  by  the  therapeutist,  in  cases  of  fever,  was  to 
obviate  the  tendency  to  debility  and  death.  A better  attention  to 
physiology  and  pathology  has  shown  that  the  great  lethiferous  agent, 
in  such  cases,  is  irritation,  and  that  death  often  results  from  this 
cause,  where  its  agency  was  at  one  time  altogether  unsuspected. 

It  has  often  been  observed,  that  where  large  collections  of  matter 
have  formed,  and  been  discharged  by  the  surgeon,  febrile  irritation 
of  the  most  fatal  kind  has  rapidly  supervened,  yet  little  or  none 
of  this  irritation  was  present  before  the  matter  was  evacuated.  It 
was  accordingly  supposed,  at  one  time,  by  every  surgeon,  that  the 
irritative  fever  was  the  result  of  debility  induced  by  its  discharge. 
It  is  obvious,  however,  that  in  such  case,  from  the  time  that  the  pus 


424 


j:xcitants. 


is  secreted,  it  is  as  extraneous  to  the  vital  operations  as  after  its  dis- 
cliarge.  The  removal  of  that  which  is  already  secreted  cannot  add 
to  the  existing  debility.  The  cause  of  the  hectic  fever,  set  up  in 
such  cases,  and  present  to  some  extent  from  the  moment  that  exten- 
sive suppuration  begins  to  be  established,  reposes  on  the  circum- 
stance, that  when  once  the  pus  is  discharged,  a recuperative  effort 
takes  place  in  the  vessels  of  nutrition  of  the  inner  paries  of  the  ca- 
vity ; and  the  severe  irritative  fever,  which  follows,  is  owing  to  the 
constitution  sympathising  with  the  excited  capillaries  to  such  an  ex- 
tent,  that  the  system  often  sinks  under  the  effects  of  its  own  repara- 
tory  exertions. 

No  one,  at  the  present  time,  conceives,  that  the  consumptive  are 
worn  away  by  the  discharge  that  takes  place  from  the  substance  of 
the  lungs.  Hectic  fever  occurs  in  phthisis  pulmonalis,  as  in  every 
other  case  where  extensive  mischief  exists,  and  great  recuperative 
effort  has  to  be  exerted  ; and,  under  the  irritation  of  this  fever,  the 
spark  is  gradually  extinguished. 

It  is  not  in  these  cases  only,  that  the  prevalent  doctrine  of  debility 
has  been  exploded.  The  practitioner,  when  he  observes  signs  of 
debility  in  an  organ  or  in  the  system  generally,  inquires,  whether  the 
vitality  of  other  organs  may  not  be  exalted,  and  whether  there  may 
not  be  a source  of  irritation  existing  somewhere,  which,  by  detract- 
ing from  the  vital  manifestations  in  other  parts,  may  be  the  cause  of 
the  local  or  general  evidences  of  asthenia  or  debility.  A strong 
man,  in  a state  of  health,  may  be  attacked  with  general  fever,  ac- 
accompanied  by  great  languor  and  lassitude,  with  every  sign,  in- 
deed, of  apparent  debility — yet  a very  slight  examination  may  ex- 
hibit, that  an  undue  quantity  or  improper  quality  of  diet  is  exciting 
gastric  irritation,  which  is  the  source  of  all  the  asthenic  phenomena. 
Again,  a man,  in  a condition  of  rude  health,  may  be  exposed  to 
febrific  miasmata ; and,  in  due  time,  without  much  previous  indis- 
position, may  exhibit  appearances  of  the  greatest  debility ; and, 
although  a short  time  before  he  might  have  been  able  to  raise  pounds, 
he  may  be  now  scarcely  able  to  raise  as  many  ounces.  Yet,  it  is 
impossible  to  presume,  that  such  debility  is  real  ; it  is  rather  depen- 
dent upon  the  excessive  irritation  in  certain  parts  of  the  organism 
detracting  from  the  vital  forces  in  others  ; and  the  important  point 
for  the  therapeutist  is,  — to  direct  his  attention  to  the  removal  of 
this  irritation,  after  which  the  effects  — the  asthenic  feelings  and 
symptoms  — may  cease  also.  Accordingly,  at  the  present  day,  no 
practitioner,  at  the  commencement  of  a febrile  condition,  is  deterred 
from  the  use  of  evacuants  by  symptoms  of  languor  and  lassitude,  — 
experience  and  reflection  having  sufficiently  instructed  him,  that  the 
proper  employment  of  such  agents  is  adapted  to  equalise  the  vital 
manifestations,  by  reducing  the  inordinate  action  existing  in  some 
part  of  the  organism,  and  thus  equalising  the  circulatory  functions 
of  the  whole. 

Even  in  cases  of  cachexia,  where  general  debility  appears  to  be 


EXCITANTS. 


425 


unequivocally  manifested,  some  lurking  mischief  is  generally  pre- 
sent ; and  when,  in  such  cases,  we  find  a change  of  the  atmosphe- 
ric, and  other  influences  surrounding  the  patient,  productive  of  sig- 
nal benefit,  it  is  owing  to  the  equalising  influence  of  change  of  air, 
society,  and  scenery,  which  detracts  from  the  local  mischief,  and  ex- 
hibits its  genial  effects  over  every  part  of  the  frame  ; hence,  the 
wonderful  recoveries  we  annually  witness  in  chronic  diseases  from 
a visit  to  our  trans- Alleghany  or  other  watering  places  ; — the  wa- 
ters having  often  had  no  agency  in  the  cure,  — frequently,  indeed, 
not  having  been  used  at  all.  Still,  there  are  conditions  of  the 
frame,  in  which  the  vital  activity  is  diminished  far  below  the  health}- 
standard  ; where  the  vascular  system  is  in  a state  of  an2emia,  the 
blood  less  rich  in  globules  and  nutritive  pabulum  ; and  the  solids  of 
loose  coherence,  so  that  the  blood  escapes  through  them  with  facility, 
or  they  rupture  on  the  slightest  mechanical  violence,  — or  when, 
after  violent  exaltation  of  the  vital  forces,  a corresponding  depres- 
sion or  state  of  collapse  supervenes.  In  such  cases,  excitants,  espe- 
cially those  of  a more  permanent  character,  may  be  imperatively  de- 
manded. 

In  the  great  division  of  excitants,  those  agents  are  usually  in- 
cluded whose  excitant  action  is  local  or  general ; in  other  words, 
is  exerted  upon  some  particular  organ  or  tissue,  affecting  it  by  pre- 
ference, and  comprising  the  class  of  local  stimulants  of  Murray,  — 
the  local  excitants  of  others,  — whose  operation  is  that  of  simple  stimu- 
lation on  the  tissue  with  which  they  are  placed  in  immediate  con- 
tact, extending  or  not  to  the  general  system,  so  as  to  produce  aug- 
mented action  of  the  nervous  and  sanguiferous  systems. 

The  classes  of  medicinal  agents,  which  act  as  general  stimulants, 
are  chiefly  — - Excitants^  Tonics^  and  Astringents  ; those  that  are 
usually  ranked  as  local  stimulants  are  — Emetics^  Cathartics,  Em^ 
menagogues,  Parturifacients,  Diaphoretics,  Errhines,  Sialagogues,  Diu~ 
reties,  and  Expectorants,  of  all  of  which  the  author  has  treated  sepa- 
rately. 

Excitants,  Stimulants,  or  Incitants,  may  be  defined  — agents  that 
increase  the  organic  actions  by  impressing  the  contractility  of  the 
part  to  which  they  are  applied  ; — the  excitation,  thus  induced,  being 
extended,  or  not,  to  the  rest  of  the  system. 

The  organ,  whose  contractility  is  generally  selected  to  be  first 
impressed,  when  excitants  are  administered,  is  the  stomach,  although 
the  skin  and  mucous  membranes  — especially  the  Schneiderian 
membrane,  and  the  lining  membrane  of  the  rectum  — are  at  times 
chosen.  The  extensive  sympathy,  which  exists  between  the  stomach 
and  the  rest  of  the  system  — particularly  the  nervous  and  sanguife- 
rous portions — renders  it  best  adapted  for  the  receipt  of  the  impres- 
sion, which  excitants  are  capable  of  producing  directly. 

In  the  classification  of  Murray,  which  is  closely  followed  by  Dr. 
Paris,  there  is  no  division  of  excitants.  The  latter  writer  has,  in- 
deed, a class  of  Aromatics,  he  defines  — Substances  of  a 

36’^ 


42G 


EXCITANTS. 


iVagrant  smell,  which  produce  upon  the  organs  of  taste  a peculiar 
sensation  of  warmth  and  pungency,  and  occasion,  when  swallowed, 
a corresponding  impulse  upon  the  stomach,  which  is  rapidly  com- 
municated to  the  remote  parts  of  the  body  but  this  definition  is 
obviously  insufficient  to  embrace  the  whole  class  of  excitants  ; as 
several  agents  of  an  exciting  character,  — caloric  and  electricity,  for 
example,  — can  in  no  wise  be  regarded  as  aromatics.  Aromatics 
can  be  looked  upon  only  as  a subdivision  of  excitants,  whose  modus 
operandi  essentially  resembles  that  of  the  whole  class. 

Of  old,  aromatics  were  employed  chiefly  as  carminatives  — a sub- 
division not  now  admitted,  although  we  still  retain  the  term,  which 
— as  before  remarked  — is  derived  from  ‘ a verse-charm,’ 

and  was  introduced  at  a period  of  superstition,  when  magic  and  in- 
cantations were  had  recourse  to,  and  when  physiology  and  pathology 
scarcely  existed. 

Carminatives  were  employed  to  expel  flatus  from  the  stomach 
and  intestines,  and  they  afford  a good  example  of  excitants,  that 
produce  their  effect  simply  on  the  parts  with  which  they  come  into 
immediate  contact,  or  at  least,  without  exciting  the  general  system. 
When  flatus  accumulates  to  any  extent  in  the  alimentary  canal,  the 
muscular  fibres  become  so  far  distended  that  atony  is  produced,  and 
they  are  incapable  of  acting  with  sufficient  energy  to  expel  the  air, 
or  to  diffuse  it  through  the  tube  ; hence,  the  pain,  which  accompa- 
nies such  over-distention  in  flatulent  colic.  But  if,  in  this  case,  an 
aromatic  or  carminative  be  administered,  the  excitement  produced 
by  it  in  the  mucous  membrane,  with  which  it  comes  in  contact,  is 
extended,  by  contiguous  sympathy,  to  the  muscular  coat,  which  is 
aroused  to  greater  contraction,  and  in  this  way,  the  flatus  is  com- 
pressed ; a part  may  escape  through  the  cardiac  orifice  of  the  sto- 
mach, if  that  organ  have  been  the  seat  of  the  affection  ; or  it  may  de- 
scend into  the  lower  intestines.  The  older  writers,  not  being  able 
to  comprehend  how  the  sudden  relief  was  accomplished  in  such 
cases,  asserted  its  operation  to  be  carminative,  or  like  that  of  a 
charm. 

Most  excitants  are  derived  from  the  vegetable  kingdom,  and  the 
property,  on  which  their  virtues  are  dependent,  is  usually  volatile 
oil,  or  some  analogous  principle  ; hence  the  action,  and  form  of  ad- 
ministration, of  vegetable  excitants  afford  but  little  difficulty  to  the 
student.  In  the  generality,  indeed,  the  active  principle  — the  vola- 
tile oil  — is  separated  by  distillation,  and  is  administered  in  this 
form,  so  that  the  plants  and  their  products,  whence  the  oil  has  been 
derived,  are  but  little  used  in  therapeutics.  This  is  the  case  with 
carraway,  aniseed,  lavender,  the  mints,  cinnamon,  cloves,  nutmeg, 
k,c.  In  other  cases,  the  oil  is  rarely  separated,  as  in  calamus, ginger, 
wood  of  sassafras,  &c.  Here,  the  sole  care  consists  in  not  applying 
heat  to  such  an  extent  as  to  drive  off  the  volatile  oil  ; and  accord- 
ingly those  agents  are  either  given  in  substance,  or  infusion,  — not 
in  decoction  or  extract. 


EXCITANTS. 


427 


The  excitants,  that  are  derived  from  the  inorganic  kingdom,  exert 
their  agency  in  various  ways.  They  have,  indeed,  no  principle  in 
common  to  w'hich  their  operation  can  be  referred. 

The  case  of  flatulent  colic  is  one  in  which  the  simple  direct  action 
of  excitants  is  desired ; and  it  is  manifest,  that  similar  principles 
would  lead  to  their  adoption  in  affections  of  the  stomach  dependent 
upon  debility  of  its  muscular  coat,  — as  indicated  by  flatulence, 
sense  of  distention,  &c.,  unaccompanied  by  inflammatory  or  other 
irritation  in  the  lining  membrane.  Accordingly,  it  is,  and  has  been, 
a common  custom  with  all  nations,  to  use  some  alcoholic  excitant 
after  food  difficult  of  digestion  has  been  taken. 

That,  which  applies  to  food  difficult  of  digestion,  applies  likewise 
to  the  cases  above  referred  to,  in  which  the  digestive  powers  are  en- 
feebled; and  to  those  especially  where  the  defect  lies  in  want  of  due 
contractility  in  the  muscular  fibres  of  the  stomach  and  small  intestines, 
— particularly  of  the  former.  When  hot  water  or  dilute  alcohol  — 
pure,  or  medicated  — is  taken  into  the  stomach,  it  produces  two 
eflfects.  It  stimulates  the  mucous  membrane  to  an  increased  secretion 
of  those  fluids,  that  are  inservient  to  digestion ; and,  by  contiguous 
sympathy,  the  muscular  fibres  are  aroused  to  greater  activity,  so  that 
the  contraction  of  the  organ  upon  its  contents  is  more  marked ; — 
hence  the  eructation,  which  follows  the  use  of  these  excitants,  and 
the  absence  of  uneasy  feelings  of  distention,  w'hich  might  have  been 
experienced  had  they  been  withheld.  Alcoholic  liquors,  moreover, 
have  a chemical  operation,  not  possessed  by  ordinary  excitants. 
They  coagulate  the  albuminous  matters  in  the  stomach,  and  may 
thus  aid  in  giving  the  contents  of  the  organ  a texture  better  adapted 
for  the  accomplishment  of  digestion.  But  occasion  will  be  afforded 
to  refer  to  the  particular  examples  of  local  stimulation,  when  the 
consideration  of  the  therapeutical  application  of  excitants  occurs. 
At  present,  it  is  necessary  to  inquire  into  the  general  effects  produced 
by  excitants,  when  their  action  is  not  restricted  to  the  part  with 
which  they  come  in  contact,  and  when  the  object  of  the  practitioner 
is  to  exhibit  them  so  as  to  affect  the  whole  system. 

The  nervous  susceptibility  is,  in  such  case,  greatly  augmented ; 
the  action  of  the  moving  fibres  increased ; the  pulse  rendered  more 
frequent  and  forcible,  and  the  function  of  calorification  excited,  — if 
the  quantity  of  the  agent  be  great,  or  its  powers  considerable. 
These  effects  must  obviously  require  a larger  dose  of  the  excitant 
than  where  the  object  of  the  practitioner  is  merely  to  produce  a local 
stimulation.  The  very  different  effects  of  excitants,  according  to  the 
(quantity  administered,  is,  indeed,  a circumstance  of  great  interest  to 
the  practitioner.  A small  dose  may  stimulate  the  lining  membrane 
of  the  stomach  to  a greater  secretion  of  the  digestive  fluids,  and  the 
muscular  fibres  to  greater  activity,  so  that  the  food  may  be  digested 
more  readily  and  rapidly  ; chylosis  be  facilitated  ; the  blood  move 
with  greater  rapidity  in  the  vessels ; and  the  various  secretions,  and 
excretions  be  more  readily  effected;  but,  if  the  dose  be  carried  far 


428 


EXCITANTS. 


be}ond  this,  irritation  mny  be  excited  in  the  part  with  which  the 
excitant  comes  in  contact,  or  true  infiammation  may  result,  so  that  a 
general  febrile  condition  may  be  induced,  under  which  many  of  the 
functions  enumerated,  instead  of  being  facilitated,  may  be  retarded 
— especially  the  secretions  and  excretions,  which  are  never  pro- 
perly accomplished  during  fever.  These,  however,  are  the  results  of 
too  strong  a dose : the  quantity  of  excitants,  by  careful  attention, 
may  be  so  tempered,  that  nothing  but  a salutary  excitation  may 
supervene ; and  this  constitutes  one  of  the  great  difficulties  in  the 
proper  therapeutical  employment  of  this  class  of  agents. 

There  is  another  important  consequence  of  stimulating  the  whole, 
or  any  part  of  the  organism  beyond  the  due  point,  — namely,  that 
a corresponding  state  of  depression  succeeds  ; so  that,  after  violent 
excitation,  collapse,  or  almost  total  prostration  may  ensue.  This 
kind  of  compensation  of  action  appears  to  exist  to  a great  extent  in 
the  organism.  If  any  organ  be  greatly  over-excited,  other  organs 
are  often  observed  to  be  struck  with  debility,  and  hence  it  is,  as  we 
have  seen,  that  the  judicious  pathologist — when  he  observes  want 
of  action,  or  apparent  atony,  in  one  organ  — carefully  investigates, 
whether  the  deficiency  of  vital  manifestation  may  not  be  compen- 
sated by  inordinate  action  elsewhere. 

This  supervention  of  collapse  on  over-excitement  renders  it  a 
matter  of  moment  to  be  able  to  determine  what  are  the  healthy  mani- 
festations, by  which  the  evidences  of  exaltation  or  diminution  of  the 
vital  forces  may  be  determined.  This,  however,  is  not  an  easy 
matter,  and  the  difficulty  is  greater  in  some  individuals  than  in  others. 
No  two  persons  have  the  functions  of  circulation,  innervation  and 
calorification  alike.  A modern  writer.  Dr.  A.  T.  Thomson,  has 
attempted  a solution  of  the  question,  by  affirming,  that  “ excitement 
implies  every  state  of  the  nervous  system  in  wffiich  the  energy  of  the 
brain  is  greater  than  that,  which,  in  the  waking  state  of  a healthy 
man,  is  exactly  adequate  to  the  ordinary  functions  of  the  system  : 
Collapse  that  state  in  which  the  cerebral  energy  is  so  much  diminished 
as  to  suspend  the  exercise  of  the  functions  of  sense  and  volition  — a 
state  of  defective  activity  of  the  brain,  similar  to  that  which  causes 
sleep,  only  in  an  augmented  degree.  There  can  be  no  doubt,  that  a 
certain  supply  of  blood  to  the  brain  is  essential  for  the  support  and 
continuance  of  its  functions;  too  great  an  increase  of  the  momentum 
produces  excitement;  a diminished  afflux,  on  the  contrary,  within 
certain  limits,  or  an  exhaustion  of  the  moving  powers  from  previous 
over-exertion,  is  productive  of  collapsed  But  these  definitions  do 
not  solve  the  difficulty.  The  constitutions  of  individuals  differ  so 
much,  that  we  cannot  easily  determine  what  are  the  healthy  mani- 
festations in  any  particular  person.  Whenever,  therefore,  excitants 
appear  to  be  indicated  in  disease,  the  therapeutist  has  to  be  cautious 
not  to  carry  the  excitation  too  far,  lest  the  vital  energies  should  be 
impaired  or  worn  out ; and  for  the  like  reason,  it  becomes  important, 
when  once  the  use  of  excitants  has  been  commenced,  that  they  should 


GENERAL  EFFECTS. 


429 


be  withdrawn  with  caution,  lest  a state  of  collapse,  or  of  diminished 
action,  should  succeed,  proportionate  to  the  preceding  stimulation. 
This  is  especially  demanded  in  protracted  fevers,  in  which  excitants 
may  still  have  been  employed  with  propriety. 

The  state  of  collapse,  referred  to  above  as  supervening  on  over- 
excitement, differs  essentially  from  that  which  attends  spasmodic 
cholera.  In  this  fatal  malady,  owing  to  the  excited  state  of  the 
lining  membrane  of  the  intestines,  the  watery  portions  of  the  blood 
are  largely  exhaled,  and  passed  off  in  the  evacuations,  until  ulti- 
mately the  blood  becomes  too  thick  to  circulate  in  the  extreme  ves- 
sels ; the  nervous  system  does  not  receive  its  due  supply  of  blood 
possessing  the  requisite  properties,  and  even  the  central  organ  of  the 
circulation,  and  the  whole  circulatory  apparatus,  have  their  functions 
impaired,  and  ultimately  annihilated.  But  this  state  of  collapse  is 
not  the  immediate  consequence  of  previous  general  excitement. 

It  will  be  seen  hereafter,  that  all  tonics  are  excitants  ; but  that  the 
former  do  not  stimulate  beyond  the  healthy  standard,  and  are  more 
permanent  in  their  action  ; whilst  the  latter  are  always  employed  to 
excite  more  or  less  beyond  the  healthy  degree,  and  are  more  tran- 
sient in  their  operation,  although  their  effects  may  be  more  speedily 
exerted. 

A valuable  mode,  in  which  some  of  the  agents  belonging  to  this 
class  of  medicines  exert  their  efficacy,  is  by  revulsion.  The  whole 
class  of  counter-irritants  and  epispastics  are  properly  excitants;  — 
but  their  intimate  examination  will  be  entered  upon  under  a distinct 
head.  (See  Revellents.)  Mercury  and  caloric  are  also  employed 
with  this  view  in  disease;  but  the  consideration  of  the  modus  ope- 
randi  of  the  former,  when  carried  so  far  as  to  affect  the  system,  will 
also  fall  in  another  place.  (See  Eutrophics.) 

The  catalogue  of  the  Materia  Medica  furnishes  us  with  a liberal 
choice  of  excitants ; yet,  so  large  a portion  of  them  essentially  re- 
semble each  other  in  their  properties,  that  the  list  might  be  much 
diminished  without  any  disadvantage  to  science  or  humanity.  There 
is  scarcely  an  aromatic  vegetable,  the  essential  oil  of  which  has  not 
been  admitted  into  the  pharmacopoeias  of  Europe,  or  of  this  coun- 
tjy,  yet  almost  any  one  of  them  might  be  selected  as  a fit  represen- 
tative of  the  whole. 

Therapeutical  Application  of  Excitants. 

Gastric  affections.  — In  the  therapeutical  application  of  the  class 
of  excitants  we  have  always  to  reflect,  whether  the  indication  be 
simply  to  effect  a local  stimulation,  or  to  have  the  excitation  extend- 
ed*to  the  general  system ; — whether,  in  other  words,  it  be  merely  a 
morbid  condition  of  the  digestive  functions,  that  has  to  be  com- 
bated, or  one  involving  the  great  systems  — nervous,  vascular  or 
secretory. 

Where  the  mischief  is  purely  gastric,  and  dependent  apparently 


430 


EXCITANTS, 


on  want  of  tone  in  the  muscular  coat  of  the  stomach,  or  in  the  organ 
generally,  the  diffusible  excitants  are  chosen,  if  the  uneasiness  be 
urgent  — as  where  is  present.  Ether,  alcoholic  liquors,  hot 

water,  the  essential  oils,  &c.,  may  be  employed  with  this  view,  but 
any  stimulation,  thus  induced,  can  only  be  momentary ; the  cause  of 
the  uneasy  symptoms  may  still  persist,  and  demand  a treatment  more 
permanent  in  its  influence.  Correct  pathology  may  suggest,  that, 
in  these  cases,  recourse  should  be  had  to  a combination  of  tonics 
and  excitants,  in  order  that,  whilst  the  latter  palliates  the  uneasy 
feelings,  the  former  may  radically  remove  the  want  of  tone  which 
gave  origin  to  them.  Accordingly,  one  of  the  bitter  roots  or  barks 
is  usually  given  in  infusion,  along  with  some  aromatic  ; — the  bitter 
})rinciple  of  the  root  or  bark  exerting  its  tonic  influence,  whilst  the 
essential  oil  of  the  aromatic  acts  as  an  excitant.  Care,  however, 
must  be  taken  to  discover,  whether  the  symptoms  are  really  pro- 
duced by  atony,  for  there  is  a variety  of  dyspepsia  — indicated,  at 
times,  by  pain  of  the  epigastrium  on  pressure  ; by  uneasiness,  when 
hot  or  cold  fluids  are  taken,  — by  dryness  and  redness  of  the  tongue  ; 
dryness  and  heat  of  skin,  with  sometimes  quickness  of  pulse, — 
which  consists,  as  the  symptoms  sufficiently  indicate,  in  an  irritated 
or  inflamed  condition  of  the  gastro- enteric  mucous  membrane,  and 
where,  of  course,  the  stimulant  plan  of  treatment  would  be  inju- 
rious. This  very  condition  of  mucous  membrane  may,  indeed,  be 
induced  by  the  incautious  use  of  excitants.  It  has  been  already  re- 
marked, that  excitation  is  followed  by  corresponding  depression  ; 
and  that  excitants,  in  an  overdose,  exalt  inordinately  the  vital  ener- 
gies of  the  part  with  which  they  come  in  contact,  so  that  if  this 
course  be  persevered  in,  the  irregular  condition  of  the  mucous  sur- 
face — as  to  alternate  excitation  and  depression  — can  scarcely  fail 
to  eventuate  in  irritation,  if  not  in  true  inflammation ; hence  it  is, 
that  excitants  alone  are  rarely  used  in  affections  of  the  digestive 
tube,  unless  for  the  removal  of  sudden  attacks  of  disease,  as  of  Jla- 
tulent  colic^  especially  in  children,  when  a few  drops  of  any  essen- 
tial oil  will  usually  remove  the  mischief,  in  the  manner  previously 
explained. 

In  persons  of  the  gouty  diathesis,  and  occasionally  in  others,  vio- 
lent attacks  of  a spasmodic  character  affect  the  stomach,  causing  the 
most  excruciating  pain,  aggravated  at  intervals,  but  with  no  signs 
whatever  of  inflammatory  excitement.  In  such  cases,  a new  action 
must  be  produced  in  the  nerves  of  the  organ,  by  the  administration 
of  the  most  diffusible  excitants  — combined,  or  not,  with  narcotics 
— until  relief  is  procured.  The  latter  class  of  remedies  affords  us 
the  most  efficacious  agents  in  these  affections ; accordingly,  more 
trust  is  reposed  in  them.  Ginger,  capsicum,  ammonta,  ether,  &c., 
are  the  excitants  usually  had  recourse  to  in  these  cases ; and  the 
effect  of  internal  agents  is  often  aided  by  the  application  of  stimu- 
lants to  the  epigastric  region,  which  operate  by  exciting  a new  action 
in  the  nerves  with  which  they  are  placed  in  direct  contact,  and  thus 


IN  FEVER. 


431 


detracting  from  the  erethism  in  the  nerves  distributed  to  the  sto- 
mach. This  kind  of  revulsive  impression  or  of  new  action  is,  in- 
deed, a main  cause  of  the  good  effects  derived  from  the  administra- 
tion of  the  pure  antispasmodics  in  diseases  of  a spasmodic  nature. 

In  cases  of  great  irritability  of  stomach,,  especially  in  the  vomit- 
ing of  pregnant  females,  which  sometimes  proceeds  to  a distressing 
extent,  a genial  effect  is  produced  on  the  stomach,  by  the  new  ac- 
tion, which  gentle  excitants  occasion.  Even  the  mild  stimulation, 
afforded  by  carbonic  acid  contained  in  soda  water,  or  extricated 
during  the  effervescence  produced  by  the  union  of  tartaric  acid  and 
carbonate  of  soda,  often  affords  marked  relief ; and,  in  the  worst 
cases,  the  exhibition  of  diffusible  excitants,  with  the  application  of  a 
sinapism  or  other  excitant  externally,  hardly  fails  to  palliate  — if  not 
to  radically  remove  — the  irritability  of  the  organ,  where  it  is  only 
functionally  deranged  ; for,  it  need  scarcely  be  said,  that  where  or- 
ganic mischief  exists;  where  inflammation,  common  or  specific,  or 
its  consequences,  are  present,  and  the  cause  of  the  vomiting,  these 
agents  will  not  only  fail  in  affording  relief,  but  may  be  positively 
noxious,  at  least  when  exhibited  internally.  In  such  cases,  the 
efforts  of  the  practitioner  are  restricted  to  the  use  of  narcotics  as 
palliatives,  and  to  the  external  application  of  excitants  as  counter- 
irritants. 

Constipation.  — In  like  manner,  in  cases  of  constipation,  unat- 
tended with  inflammation,  and,  on  the  contrary,  accompanied  by 
great  torpor  of  the  digestive  function,  the  addition  of  an  aromatic 
excitant  to  the  cathartic  is  beneficial,  by  stimulating  the  muscular 
coat  through  the  mucous  coat ; whilst  it  may  act  as  a corrigent  to  the 
cathartic,  if  the  latter  have  any  griping  quality,  by  aiding  it  in  its 
passage  through  the  intestinal  canal,  in  the  mode  already  described. 

Fever.  — It  need  scarcely  be  said,  that  excitants  must  be  employ- 
ed with  extreme  caution  in  fever.  At  one  time  — as  already  re- 
marked—the  great  indication  in  these  affections  was  supposed  to 
be, — to  obviate  the  tendency  to  debility  and  death,  and,  accord- 
ingly, antiphlogistics,  especially  of  the  depleting  kind,  were  used 
with  great  Ihesitation,  and  every  thing  was  done  to  husband  the 
strength  so  as  to  permit  the  patient  to  bear  up  in  the  last  stages.  A 
better  system  fortunately  now  prevails,  and.  it  is  universally  admit- 
ted, that  few,  if  any,  die  from  febrile  debility,  and  that  the  fatal  in- 
fluence is  seated  in  the  over-irritation  of  some  tissue  or  tissues, 
under  which  the  patient  gradually  succumbs.  The  efforts  of  the 
practitioner  are,  therefore,  properly  directed  to  the  prevention  of  ir- 
regular action  in  organs,  and  to  the  removal  of  irritation,  or  inflam- 
mation, wherever  existent.  Under  this  philosophical  treatment  of 
fever,  excitants  are,  of  course,  never  employed  during  the  early  pe- 
riods, and  it  is  only  when  the  powers  of  life  begin  to  flag,  that  a 
question  can  ari^'e  as  to  the  propriety  of  their  adoption.  Even  in 
the  very  lowest  stages  of  the  worst  grades  of  typhus,  this  question 


432 


EXCITANTS, 


is  not  always  very  easily  settled.  There  is  generally  more  or  less 
local  irritation  present  — often  in  the  lining  membrane  of  the  -sto- 
mach and  intestines  — and  many  of  the  signs  of  debility  are  de- 
pendent upon  the  depressing  influence  exerted  on  other  functions  by 
the  predominance  of  irritation. 

This  depressing  influence  on  the  sanguiferous  system  is  often  sin- 
gularly evinced  in  diseases  of  the  intestinal  canal,  especially  such  as 
aflect  the  lining  membrane  ; and  a striking  example  of  it  is  seen  in 
cholera.  The  author  attended  with  his  friend,  Professor  Smith,  of 
the  University  of  Maryland,  one  of  the  students  of  the  University, 
who,  after  having  been  present  at  the  lecture  of  the  Professor  of 
Obstetrics,  in  the  evening,  was  attacked  with  violent  vomiting,  but 
without  any  abdominal  or  other  uneasiness.  On  the  following 
morning,  there  was  some  slight  tenderness  on  pressure,  and  the 
vomiting  persisted.  He  was  cupped  over  the  abdomen,  although 
neither  the  state  of  the  pulse,  of  the  skin,  nor  the  other  symptoms 
appeared  to  indicate  inflammatory  action.  During  the  day,  he  gra- 
dually sank,  and  expired  the  same  evening.  On  examining  the 
body,  a portion  of  the  ileum  was  found  contracted  for  the  space  of 
several  inches,  but  this  contraction  must  have  formed  gradually.  The 
lining  membrane  exhibited  but  slight  signs  of  irritation.  There  is 
something,  indeed,  extremely  unaccountable  in  these  cases.  The 
peristole  of  the  digestive  tube  is  but  indirectly  influenced  by  the 
brain  and  spinal  marrow.  The  heart  itself  is  equally  abstracted 
from  direct  cerebro-spinal  influence,  and,  indeed,  from  almost  all 
nervous  influence  ; yet,  in  enteritis,  the  whole  circulatory  apparatus 
is  oppressed,  as  it  were  ; and  this  oppression,  if  not  removed,  ra- 
pidly terminates  in  depression  ; whilst,  in  the  comparatively  harm- 
less disease — amygdalitis^  or  inflammatory  sore  throat  — the  action 
of  the  heart  is  inordinately  excited,  and  the  whole  vascular  system 
thrown  into  violent  turmoil. 

It  is  generally  considered  proper  to  have  recourse  to  excitants  in 
fever,  when  the  pulse  and  the  beat  of  the  heart  become  feeble  and 
fluttering  ; the  tongue  moist  perhaps,  but  wdth  a dark  fur  ; the  teeth 
covered  with  sordes  ; the  skin  bathed  in  a cold,  clammy  sweat;  or, 
if  hot  and  dry,  with  concomitant  symptoms  of  debility  ; sinking 
down  in  the  bed,  and  low  muttering  delirium  ; the  tongue  tremu- 
lous, and  protruded  with  difficulty,  — indicating  great  debility  of  the 
nervous  system ; petechise  or  vibices,  produced  by  transudation  of 
blood,  rendered  thin  by  disease,  through  the  loosened  parietes  of 
vessels,  &c.,  &c.  But  it  is  impossible  to  lay  down  any  positive 
rules  for  the  guidance  of  the  practitioner,  and  it  is  better,  that  he 
should  even  allow  the  signs  of  prostration  to  become  marked,  before 
he  passes  to  the  too  early  use  — as  it  may  prove  to  have  been  — of  ex- 
citants. Dr.  Rush,  as  before  remarked,  considered,  that  there  was 
a period  in  fevers,  at  which  blisters  might  be  applied  as  excitants 
with  great  advantage;  but,  if  used  before  this  period,  they  w^ould 


IN  INFLAMMATORY  DISEASES. 


433 


be  productive  of  mischief.  It  is,  however,  impossible  to  fix  upon 
any  such  point  with  accuracy  ; and  in  this,  indeed,  the  main  difli- 
culty  rests.  If  it  could  be  decided  on  by  any  specific  signs,  it  would 
be  but  necessary  to  apply  the  antiphlogistic,  or  the  excitant  medica- 
tion accordingly.  Vesicants,  are,  however,  by  no  means  the  best 
agents  to  be  employed  as  excitants.  In  the  low  conditions  of  the 
frame,  in  which  they  are  conceived  to  be  indicated,  the  discharge 
of  a quantity  of  the  serous  part  of  the  blood  cannot  fail  to  add  to 
the  debility  more  than  the  excitant  property  can  detract  from  it : 
they  produce,  moreover,  excessive  irritation,  and  are,  withal,  tran- 
sient in  their  operation.  A more  permanent  excitant  is,  therefore, 
better  adapted  to  these  cases  ; and  internal  stimulants — as  wine  — 
are  preferred,  the  quantity  being  carefully  regulated  so  as  not  to 
excite  beyond  the  due  degree.  Under  another  head,  it  will  be 
seen,  that  epispastics  may  be  employed  with  decided  advantage 
in  fever,  but  not  on  the  principle  of  inducing  general  excitation. 
(See  Revellents.) 

Whenever  excitants  are  esteemed  necessary  in  fever,  the  fact, 
before  adverted  to,  must  be  borne  in  mind,  that  their  operation  is 
apt  to  be  followed  by  corresponding  depression.  They  should  be 
administered,  consequently,  so  frequently,  that  the  depression  has 
not  time  to  intervene,  care  being  taken,  that  they  are  not  given  in 
such  doses  as  to  excite  beyond  the  proper  point ; and,  if  their 
operation  be  salutary,  they  will  be  found  to  detract  from,  rather 
than  add  to,  the  febrile  irritation  : if,  however,  the  febrile  symptoms 
should  be  manifestly  increased  under  their  administration,  they  must 
be  discontinued  — but  discontinued  gradually  — for  the  reasons 
mentioned. 

These  general  views  will  afford  some  guidance  to  the  use  of  ex- 
citants in  febrile  complaints  in  general.  The  author  has  already  said, 
that  in  such  affections  they  are  but  little  needed,  and  that  they  must, 
in  all  cases,  be  employed  with  a wise  caution.  The  case,  indeed, 
must  be  sufficiently  hopeless,  in  which  the  elasticity  of  the  frame  is 
incapable  of  restoring  it  to  its  wonted  energies  without  their  agency  ; 
and  very  often  — too  often  — when  they  are  determined  upon,  they 
occasion,  at  the  most,  a slight  flickering  of  the  flame  prior  to  its  total 
extinction.  It  is  a common  argument  m favour  of  the  administra- 
tion of  excitants,  that  it  is  the  duty  of  the  practitioner  to  support  the 
patient  as  long  as  life  lasts  ; and  the  belief  is  almost  universal,  that 
existence  can  be  prolonged  by  the  full  use  of  stimulants  ; but  this 
appears  to  the  author  to  be  questionable  There  is,  in  these  extreme 
cases,  but  a small  amount  of  excitability  remaining  in  the  organism  ; 
and  this,  it  appears  to  him,  must  be  sooner  exhausted  by  exci- 
tants ; so  that  the  patient  may  absolutely  die  more  speedily  under 
the  use  of  agents  administered  with  the  view  of  protracting  his 
existence. 

Inflammation.  — What  has  been  said  of  the  impropriety  of  exci- 
voL.  I. — 37 


434 


EXCITANTS, 


tants  in  febrile  affections  applies  equally  to  inflammatory  diseases. 
They  are,  obviously,  positively  improper  in  all  acute  inflammations 
of  internal  organs  of  every  kind.  This,  at  least,  is  a general  rule  to 
which  we  ought  to  be  cautious  of  admitting  exceptions.  Some  sur- 
geons are  in  the  habit  of  administering  copaiba  and  cubebs  during 
the  inflammatory  periods  of  gonorrhoea  virulenta,  and,  they  assert, 
with  full  success.  In  the  experience  of  others,  these  agents  have  not 
been  as  successful,  or  as  innocuous.  Something  may  depend  upon 
the  peculiarity  of  the  inflammation  of  mucous  membranes  to  which 
the  author  has  referred,  and  will  have,  again  and  again,  to  advert. 
His  experience  in  these  cases,  and  it  has  not  been  limited,  leads 
him  to  treat  the  disease  by  antiphlogistics,  especially  in  its  early 
stages,  and  he  has  always  found  the  plan  successful.  There  is, 
however,  a condition  in  these  catarrhs^  — as  inflammations  of  the 
mucous  membrane  in  general  are  often  designated  by  the  French 
pathologists, — in  which  excitants  may  be  administered  with  signal 
advantage.  It  is  when  the  violence  of  the  inflammation  has  sub- 
sided, and  when  a discharge  is  still  kept  up,  owing  to  the  atonic  or 
asthenic  condition  of  over-distended  extreme  vessels,  — hence,  in  the 
state  of  chronic  inflammation  of  the  intestines,  constituting  the  latter 
stages  of  acute  dysentery,  or  in  the  after  stages  of  diarrhoea,  that 
excitants  may  occasionally  be  used  with  benefit ; but  here  recourse 
is  had  generally  to  those  that  belong  to  another  class  of  medici- 
nal agents  — astringents. ' In  bronchitis,  too,  especially,  in  the  variety 
which  affects  old  people,  and  which  was,  at  one  time,  called  catar- 
rhus  senilis^  excitants  are  employed  with  advantage,  especially  such 
as  are  inhaled,  and,  in  this  way,  come  in  contact  with  the  vessels 
affected. 

Hypertrophy  of  the  heart.  — Where  hypertrophy  of  the  heart  ex- 
ists— as  indicated  by  strong  impulse,  diminished  sound,  dulness  on 
percussion,  and  other  signs  afforded  by  auscultation  — excitants  are, 
of  course,  improper.  Modern  pathology  has  shown,  that  where 
such  a condition  of  the  heart  is  present,  the  tendency  is  laid  to  hy- 
per0emid  in  the  brain  ; and,  hence,  vertigo,  depravation  of  vision, 
cephalalgia,  &c.,  are  its  frequent  attendants.  There  are,  however, 
no  morbid  states  of  the  heart,  and  none  of  the  blood-vessels,  — ex- 
cept such  as  are  indicated  by  over-distension  of  the  subcutaneous 
veins,  and  but  few  cases  of  these,  — in  which  excitants  can  be  em- 
ployed with  propriety. 

JYeuroses.  — In  some  of  the  neuroses,  excitants  are  demanded,  but 
they  must  be  used  with  due  caution. 

Delirium  tremens.,  in  its  severe  forms,  has  been  considered  by 
some  to  imperiously  demand  the  employment  of  powerful  alcoholic 
excitants  ; but,  as  the  author  has  shown  hereafter,  they  are  by  no 
means  indispensable,  and  the  disease  admits  of  cure  without  the  use 
of  any  of  them.  (See  the  article  Alcohol^  under  Special  Exci- 
tants.) 

In  hysteria.,  excitants  are  frequently  administered  for  the  purpose 


IN  PARALYSIS. 


435 


of  exciting  a new  impression.  The  disease  is  manifestly  neuro- 
pathic, and  is  usually  dependent  upon  great  excitability  in  the  cere- 
bro-spinal  and  nervous  system.  The  object  of  the  practitioner  is 
to  break  in  upon  this  morbid  irregularity  of  action  by  making  a 
powerful  impression  elsewhere.  (See  Antispasmodics.) 

In  epilepsy^  chorea^  tetanus^  neuralgia^  we  have  but  rarely  re- 
course to  excitants,  because  the  nature  of  the  diseased  action  re- 
quires a more  permanent  medication,  which  tonics  are  better  able  to 
effect.  There  may,  indeed,  be  cases,  — as  in  every  other  class  of 
diseases,  in  which  they  are  generally  to  be  avoided  — that  may  re- 
quire their  administration  ; but  all  this  must  be  decided  by  a refer- 
ence to  general  principles. 

Paralysis,  — Perhaps  there  is  no  neuropathic  affection,  in  which 
<he  whole  train  of  symptoms  would  appear  to  suggest  the  adminis- 
tration of  excitants  more  than  paralysis.  The  name,  (from  ?rapthva<, 

I relax,”)  and  the  symptoms  convey  the  idea  of  loss  of  power, 
and  it  might  appear  that  in  all  cases  attempts  should  be  made  to 
restore  it  by  the  use  of  excitants.  They  cannot  always,  however, 
be  used  with  perfect  safety.  Paralysis  is  often,  if  not  usually,  in- 
duced by  a hypereemic  condition  of  the  encephalon,  or  of  some  por- 
tion of  the  cerebro-spinal  axis  ; and  although  this  state  of  hyperee- 
mia  may  disappear,  and  the  resolutio  nervorum  — as  it  was  once 
called  — continue;  excitants,  if  incautiously  exhibited,  may  en- 
danger the  recurrence  of  the  hypereemia,  and  thus  give  occasion  to 
another  attack  of  the  disease.  Of  course,  the  nearer  to  the  period 
of  the  paralytic  seizure,  the  greater  the  mischief  likely  to  ensue 
from  the  injudicious  employment  of  this  system  of  medication. 

Yet  although  the  incautious  use  of  excitants  has  to  be  avoided 
in  cases  of  paralysis,  their  careful  administration  is  occasionally  pro- 
ductive of  much  benefit,  — both  in  hemiplegia,  paraplegia,,  and  in 
cases  of  partial  palsy,  such  as  that  caused  by  the  poison  of  lead,  for 
example.  The  whole  class  of  epispastics  is  here  much  employed. 
Electricity  and  galvanism,  acupuncturation,  moxa,  &c.,  are  applied 
to  rouse  the  paralysed  nerves  to  action  ; friction,  too,  is  recom- 
mended, along  with  the  internal  use  of  excitants, — such  as  affect 
the  cerebro-spinal  system  more  especially.  With  this  view,  nux 
vomica,  and  especially  its  active  principle  — strychnia — has  been 
exhibited,  and  in  a few  cases  apparently  with  partial  success.  It 
has  been  shown,  that  when  this  energetic  agent  is  taken  for  a due 
time,  and  in  an  appropriate  dose,  it  occasions  tetanic  convulsions  in 
the  muscles  to  which  the  paralysed  nerves  are  distributed,  and  con- 
sequently, seems  well  adapted  for  exciting  a salutary  stimulation  in 
these  cases,  (p.  385.)  Too  often,  however,  the  cause  of  paralysis, 
seated  as  it  is  in  the  cerebro-spinal  axis,  baffles  every  effort  for  its 
removal,  and  is  far  beyond  the  reach  of  excitants  — either  internal 
or  external.  It  ought  not,  indeed,  to  be  expected,  that  the  latter 
could  have  much  influence.  Friction,  so  often  employed,  blisters ' 


436 


EXCITANTS, 


and  other  external  irritants  can  only  exert  their  primary  action  on 
the  parts  secondarily  affected.  In  this  way,  the  encephalon,  it  is 
true,  may  receive  the  excitant  irradiations,  but  the  effect  cannot  be 
p^reat,  and,  accordingly,  external  excitants  are  not  regarded  as  effi- 
cacious agents  in  these  diseases. 

In  the  paralysis  of  the  seventh  pair  of  nerves  distributed  to  the 
face,  as  it  is,  generally  perhaps,  local  — rarely  encephalic  — and 
therefore  of  comparatively  favourable  prognosis  — the  class  of  exci- 
tants may  be  had  recourse  to,  with  much  prospect  of  advantage. 

Local  inilarnmation.  — In  many  cases  of  local  inflammation  — 
seated  on  the  surface  of  the  body,  and  affecting  the  skin  more  espe- 
cially— the  application  of  excitants  is  often  of  unequivocal  efficacy. 
It  has  long  been  a custom  to  expose  a burnt  part  to  the  radiation  of 
heat,  or  to  hot  lotions,  and  the  success  of  the  recommendation  is 
often  signal.  Shakspeare  alludes  to  the  practice,  and  to  the  fancied 
law  of  the  economy,  in  his  “ Romeo  and  Julietd’’ 

“ Tut,  man  ! one  fire  puts  out  another’s  burning  : 

One  pain  is  lessened  by  another’s  anguish  : 

Turn  giddy  and  be  help  by  backward  turning  ; 

One  desperate  grief  cures  with  another’s  languish. 

Take  then  some  new  infection  to  thine  eye, 

And  the  rank  poison  of  the  old  will  die,” 

Romeo  and  Juliet^  Act.  1.  Sceste  ii. 

In  like  manner,  in  'paronychia  or  whitlow,  especially  when  super- 
ficial, the  pain  and  inflammation  are  relieved  by  lotions  of  hot  alco- 
hol or  hot  vinegar ; and  we  have  examples  of  the  same  modus  ope- 
randi  in  the  influence  of  capsicum  and  other  stimulating  gargles  in 
inflammatory  sore  throat ; — of  stimulating  applications  in  pei'nio  or 
chilblain  ; of  hot  lotions  in  mastitis ; of  oil  of  lemon  dropped  upon  the 
inflamed  conjunctiva,  &c.  It  has  been  before  shown,  that,  in  the  in- 
flammations of  the  dermoid  system  — cutaneous  or  mucous  — as  a 
general  rule,  the  over-distended  state  of  the  capillary  vessel  predomi- 
nates over  the  excitation  of  the  blood-vessel  communicating  with  it, 
and  that  the  capillaries  are  in  a state  of  hypersemia,  which  occasions 
the  motion  of  the  blood  through  them  to  be  retarded,  and,  at  times, 
absolutely  arrested.  Any  thing,  consequently,  that  will  stimulate 
the  over-dilated  capillaries  to  resume  their  wonted  calibre,  may  re- 
move the  cause  of  the  excited  state  of  the  vessels  communicating 
with  them,  and,  consequently,  put  a stop  to  the  inflammation.  We 
may  thus  account  for  the  good  effects  of  blisters  in  whitlow,  and  in 
cutaneous  inflammations.  Occasionally,  too,  excitants  are  employed 
to  diminish  the  sensibility  of  particular  nerves,  — as  in  toothache. 
For  this  purpose,  the  strongest  essential  oils,  — > as  the  oil  of  origa- 
num, or  the  oil  of  cloves,  — are  introduced  into  the  hollow  of  the 
tooth,  so  as  to  come  in  contact  with  the  exposed  nerve. 

Friction  is  an  excitant  application,  which  is  had  recourse  to  espe- 
cially after  the  use  of  the  cold  bath,  to  excite  reaction.  It  is  also 


IN  SURGICAL  AFFECTIONS. 


437 


employed  to  modify  the  action  of  the  vessels  of  nutrition,  to  occasion 
the  absorption  of  elfused  or  secreted  matter : but,  in  this  point  of 
view,  its  effect  is  eutrophic,  and  will,  therefore,  engage  attention  in 
another  place.  (See  Eutrophics.) 

Surgical  affections.  — In  the  hands  of  the  surgeon,  excitants  are 
valuable  agents.  He  employs  them  for  inducing  a new  action  inin- 
dolent  ulcers.,  and  for  exciting  the  action  of  the  absorbents  to  take  up 
parts  that  have  been  deposited.  It  is  with  this  view,  that  white 
sugar  is  blown  into  the  eye,  in  cases  of  specks  of  the  cornea.  (See 
Saccharum.,  under  Revellents.)  The  same  agent  has  likewise  been 
recommended  to  be  inhaled,  finely  pulverised,  to  aid  in  the  disengage- 
ment of  the  adventitious  membrane,  formed  in  cases  of  diphtheritis 
of  the  mucous  membrane  of  the  trachea.  For  the  like  purpose,  cer- 
tain astringents  are  employed  occasionally. 

Lastly  : — to  the  class  of  mental  excitants  belong  certain 
emotions,  whose  effects  on  the  economy  are  not  less  marked  than 
those  produced  by  physical  agents. 

It  has  been  the  custom  to  separate  the  various  emotions  into  two 
divisions,  — the  exciting  and  the  depressing.,  — an  arrangement 
which,  in  some  measure,  expresses  the  effects  on  the  system  which 
they  are  respectively  capable  of  inducing.  There  is,  however,  as 
has  been  properly  remarked  by  Dr.  A.  T.  Thomson,  a difference 
amongst  excitants  in  the  degree  to  which  they  stimulate  the  different 
functions.  Some  excite  but  little,  and  their  action  is  more  perma- 
nent, and  not  followed  by  the  depression  which  supervenes  on  the 
use  of  the  more  powerful.  They,  consequently,  belong  rather  to  the 
class  of  tonics.  The  writer,  just  referred  to,  places,  in  the  list  of 
mental  excitants,  joy  and  impetuosity, — emotions,  which  — it  will 
be  generally  agreed — belong  properly  to  this  division  of  therapeu- 
tical agents.  There  is  not  a general  effect,  which  follows  the  ad- 
ministration of  physical  excitants,  that  they  are  not  capable  of  in- 
ducing. It  is  obviously  difficult,  however,  to  have  recourse  to  joy 
as  a remedial  agent.  It  has  happened,  that  the  communication  of 
glad  tidings  has  had  the  most  salutary  effect  upon  the  hypochondriac, 
and  the  melancholic  ; but  the  remedy  is  not  easy  of  application,  and 
the  effect  must  be  transient.  Excessive  joy  may  even  arrest  the 
functions  of  the  brain,  and  there  are  cases  on  record,  in  which  death 
has  followed  so  rapidly  on  the  emotion  as  to  suggest  the  same  ratio 
moriendi  as  in  death  from  lightning  ; — the  sudden  shock  to  the  ner- 
vous system  being  too  great  for  the  vital  functions  to  withstand. 

Allied  to  joy  is  a cheerful  disposition,  — hilarity,  and  its  accom- 
paniment laughter.  Every  therapeutist  has  observed  the  aid,  which 
such  a disposition  affords  to  the  invalid,  and  the  injurious  influ- 
ence of  depressing  emotions.  At  the  same  time,  care  must  be  taken 
not  to  allow  buoyancy  of  spirits  to  lead  the  individual  into  impru- 
dence, and  to  indulge  in  mental  excitement  to  too  great  a degree. 
The  stimulus,  communicated  to  the  whole  frame  in  this  way,  where 
there  is  a tendency  to  irregularity  of  nervous  or  vascular  action,  is 
37^ 


438 


EXCITANTS. 


apt  to  lead  to  hyperaemia  in  some  organ,  and  in  this  way  to  induce 
unpleasant  consequences.  In  febrile  affections,  and  in  the  state  of 
irritability,  which  occasionally  exists  for  some  days  after  delivery, 
the  excitation,  occasioned  by  exhilarating  conversation,  and  the 
fatigue  thus  induced,  react  injuriously  in  many  cases;  and  the  wise 
therapeutist  is  careful  to  enjoin  both  mental  and  corporeal  quietude, 
until  the  vital  functions  are  more  regularly  exerted,  and  less  liable 
to  be  deranged  by  excitant  or  other  influences. 

When  mirth  is  accompanied  with  laughter,  we  have,  in  addition 
to  the  excitant  effects,  derangements  of  another  kind  induced,  pro- 
vided the  laughter  be  immoderate  or  unduly  protracted.  Laughing 
is  a convulsive  action  of  the  muscles  of  respiration  and  of  the  voice. 
It  consists  of  a succession  of  short,  sonorous  expirations.  The  air 
is  first  inspired,  so  as  to  fill  the  lungs.  To  this,  short  interrupted 
expirations  succeed,  caused  by  convulsive  contractions  of  the  dia- 
phragm ; and,  in  very  violent  laughter,  the  respiratory  muscles  are 
thrown  into  such  forcible  contraction,  that  the  hands  are  compelled 
to  be  applied  to  the  sides  to  support  them.  The  convulsive  action 
of  the  chest  interferes  with  the  circulation  of  the  blood  through  the 
lungs ; that  fluid,  consequently,  stagnates  in  the  upper  part  of  the 
body,  and  the  face  becomes  suffused. 

From  this  explanation  of  the  physiology  of  laughter,  it  can  be 
understood,  how  injurious  it  may  be,  when  immoderately  indulged, 
to  those,  who  are  predisposed  to  apoplexy,  of  which  it  may  be,  in 
this  way,  occasionally  an  exciting  cause.  It  is  a symptom,  likewise, 
in  hysteria,  and,  in  the  hysterical,  is  apt  to  induce  a paroxysm,  if 
carried  to  too  great  a length  ; but,  on  the  other  hand,  in  cases  in 
Avhich  the  functions  of  the  abdominal  viscera  are  torpid  ; where 
asthenic  dyspepsia  is  present ; or  constipation,  arising  from  a like 
cause  ; or  where  the  secretion  from  the  liver  is  not  properly  effected, 
gentle  laughter  is  a useful  agent.  It  impresses  a salutary  succus- 
sion  on  those  organs  ; excites  them  from  their  condition  of  torpor  ; 
improves  chylosis,  and  the  digestive  function  generally  ; and  is  in- 
servient to  the  due  nutrition  of  every  part  of  the  frame.  Hence  the 
old  proverb  — laugh  and  grow  faV'^  — which,  like  most  proverbs, 
is  in  some  degree  bottomed  in  reason. 

Impetuosity^  in  which  w’e  include  rage,  or  any  sudden  and  in- 
tense mental  excitation  of  any  kind,  acts  like  joy,  which  might, 
indeed,  have  been  considered,  with  propriety,  under  the  head  of 
impetuosity.  All  the  bad  effects,  described  as  likely  to  be  induced 
by  joy,  may  follow  it ; and  many  are  the  cases  of  chronic  diseases  of 
the  heart  and  lungs,  in  which  a sudden  burst  of  passion  has  at  once 
closed  the  earthly  career  of  the  sufferer. 

We  know  that  although  the  heart  does  not  appear  to  be  directly 
influenced  by  either  the  brain  or  spinal  marrow,  its  irritability  is 
considerably  affected  by  the  various  emotions,  and  when  these  are 
violent,  and  the  organ  is  in  a morbid  condition,  the  effect  on  the 
irritability  is  so  great,  that  the  action  of  the  heart  .may  cease,  and 


CINNAMOMUM. 


439 


there  may  not  be  a sufficient  degree  of  reaction  for  it  to  resume  its  func- 
tions. Where  the  valves  of  the  heart  have  been  diseased,  the  fatal 
event  has  occurred  at  once  under  the  influence  of  powerful  mental 
excitation. 

Such  are  the  chief  therapeutical  properties  of  the  class  of  Exci- 
tants. The  next  class,  which  will  be  considered,  does  not  differ 
essentially  in  intimate  operation  from  them.  Tonics,  are,  however, 
capable  of  being  administered  when  excitants  cannot,  without  danger 
of  injurious  consequences  : occasionally,  also,  they  are  given  with 
excitants,  when  the  object  is  to  produce  more  stimulation  than  pure 
tonics  are  capable  of  effecting. 


SPECIAL  EXCITANTS. 

1.  CINNAMO'MUM.  — CINNAMON. 

Cinnamon  is  the  bark  of  Cinnamo’mum  Zeylan’icum  and  C,  aro- 
mat'icum;  Sex.  Syst.,  Enneandria  Monogynia ; Nat.  Ord.  Lau- 
raceae,  (Lindley,)  which  are 
cultivated  chiefly  in  Ceylon 
and  Java,  and  likewise  in  the 
Isle  of  France,  Bourbon,  the 
Cape  de  Verds,  Brazil,  Cay- 
enne, several  of  the  West 
India  Islands  and  Egypt. 

In  the  cinnamon  gardens  of 
Ceylon,  the  bark  is  obtained 
from  the  three  year  old 
branches,  which  are  lopped 
off,  and  peeled, — the  peel- 
ing being  effected  by  making 
two  opposite — or,  when  the  branch  is  thick,  three  or  four  longitudi- 
nal— incisions,  and  then  elevating  the  bark  by  introducing  the  peel- 
ing knife  beneath  it. 

By  far  the  greater  part  of  the  cinnamon  brought  to  this  country 
is  said  to  be  imported  from  China,  which  is  entered  at  the  custom 
house  as  Cassia^  whilst  the  same  article  brought  from  other  sources 
is  said  to  be  almost  uniformly  entered  as  Cinnamon.  By  an  exan  i- 
nation  of  the  treasury  returns,  from  the  year  1820  to  1829,  it  ap- 
peared, that  the  average  annual  import  of  this  spice  was,  in  round 
numbers, 652,000  pounds  from  China  ; 12000  pounds  from  England  ; 
9000  pounds  from  the  British  East  Indies  ; 3000  pounds  from  the 
West  Indies,  and  an  insignificant  quantity  from  all  other  places. 


Fig.  61. 


Cinnamomum  Zcylanicum. 


440 


SPECIAL  EXCITANTS. 


with  the  exception  of  12,75S  pounds,  brought  in  one  year  from  the 
Philippines.  (Wood  & Bache.) 

It  would  appear,  that  in  England,  the  consumption  of  cassia  is 
much  greater  than  that  of  cinnamon  ; as  in  1838,  the  quantity  of 
cassia  on  which  the  duty  of  Qtd.  per  pound  was  paid,  was,  according 
to  Dr.  Pereira,  88,971  pounds ; whilst  that  of  cinnamon  was  16,605 
pounds. 

Ceylon  cinnamon  has  an  aromatic  odour,  and  a pleasantly  pun- 
gent sweetish  taste,  which  is  dependent  upon  its  essential  oil.  Its 
colour  is  a light  yellow  brown.  The  pieces  are  quilled  within  each 
other,  and  some  of  them  not  thicker  than  paper:  they  are  pliable, 
and  have  a splintery  fracture,  especially  in  the  longitudinal  direction. 

The  Chinese  cinnamon  or  cassia  resembles  the  Ceylon  cinnamon 
in  many  respects.  The  odour  and  taste  are  similar,  but  not  so  deli- 
cate and  agreeable.  The  quills,  too,  are  coarser,  and  in  single 
tubes.  It  is  not,  however,  always  quilled.  It  is,  also,  of  a darker 
colour  than  the  finest  of  the  East  India  Company’s  cinnamon,  and 
is  thicker,  rougher,  denser  ; and  breaks  with  a shorter  fracture.  It 
is  the  kind  of  cinnamon  generally  kept  in  the  shops  of  the  United 
States ; and  possesses  all  the  virtues  of  the  finer  cinnamons,  and  on 
account  of  its  being  much  cheaper  is  to  be  preferred. 

The  medicinal  properties  of  cinnamon  being  dependent  upon  its 
essential  oil,  they  are  readily  yielded  to  alcohol,  and,  to  a certain 
extent,  to  water.  Like  the  other  spices,  they  are  excitant ; and, 
accordingly,  an  infusion  of  cinnamon  — cinnamon  tea  — is  some- 
times given  in  flatulence  as  a carminative,  and  wherever  an  agreea- 
ble aromatic  is  needed.  It  is  rarely  administered  alone  ; but  forms 
part  of  numerous  officinal  preparations,  to  which  it  is  added,  either 
to  render  the  preparation  more  agreeable,  or  to  aid  in  the  action  of 
the  principal  and  perhaps  less  agreeable  ingredients.  The  dose  of 
cinnamon  in  powder  is  from  ten  grains  to  a scruple. 

O'LEUM  ClMAMO'Ml,  OIL  OF  CIN'NAMON.  This  is  the  volatile  oil  of  the 
bark  of  Cinnamo'mum  Zeylan'icum^  and  C.  aromat'icum.  It  is  not 
distilled  in  this  country,  and  is,  therefore,  placed  amongst  the  arti- 
cles of  the  materia  medica  in  the  Pharmacopoeia  of  the  United 
States.  It  is  obtained  altogether  from  the  East.  An  inferior  oil  is 
obtained  from  the  Chinese  cinnamon,  which  is  called  Oil  of  Cassia, 
and  is  said  to  be  frequently  mixed  with  oil  of  cinnamon. 

Oil  of  cinnamon  has  the  odour  of  the  bark ; and  its  taste  is  pun- 
gent and  hot ; it  is  of  a pale  yellow  colour,  and  sinks  in  water.  It 
is  soluble  in  alcohol,  with  which  it  is  'said  to  be  frequently  adulte- 
rated, as  well  as  with  fixed  oil.  It  has  all  the  medical  properties  of 
the  bark  ; and  is  used  in  the  same  cases  as  the  other  essentials  oils 
— especially  in  gastrodynia,  and  enteralgia  arising  from  flatulence. 
It  is  added,  also,  as  an  adjuvant  to  other  medicines.  As  a powerful 
excitant  it  is  sometimes  used  to  allay  the  pain  of  dental  caries,  being 


ANISUM.  441 

inserted  into  the  hollow  of  the  tooth.  The  dose  is  viii  to  r»viij, 
dropped  on  sugar. 

AQUA  CINMMO'MI,  CIN'NAMON  AVATER.  ( 01.  cinnam.  f.  5ss  ; Magnes.  car^ 
honat.  5SS  ; Aquce  destillatas,  Oij.)  Cinnamon  water  is  chiefly  used 
as  a vehicle  for  other  medicines  ; but  it  is  sometimes  prescribed 
alone  as  a carminative. 

PULYIS  AROMAT'ICUS,  AROMATIC  POWDER;  Pulvis  Cinnamomi  composi- 
tus.  {Cinnam..,  Zingib.  aa  5 b ; Car  dam..,  MynsticcBy  aa  JjO  Dose, 
as  a carminative,  from  gr.  x to  xx  ; but  it  is  chiefly  used  as  an  ad- 
juvant or  corrigent  to  other  agents. 

TINCTU'RA  CINNAMO'MI,  TINCTURE  OF  CIN'NAMON.  {Cinnam.  contus.  |iij ; 
Alcohol,  dilut.  Oij.  It  may  also  be  prepared  by  the  process  of  dis- 
placement.) Tincture  of  cinnamon  is  used  as  a carminative  alone; 
but  it  is  more  commonly  added  to  tonic  and  astringent  mixtures. 
Dose  f.  3j  to  ^iij. 

TINCTU'RA  CINNAMO'MI  COMPOS  ITA,  COMPOUND  TINCTURE  OF  CIN'NAMON. 
{Cinnam,  contus.  5j  ; Cardamom,  contus.  5^®  5 Zingib.  contus.  5^^  > 
Alcohol,  dilut.  Oij.  It  may,  likewise,  be  prepared  by  the  process  of 
displacement.)  Used  in  the  same  cases  as  the  simple  tincture. 
Dose,  f.  5j  to  f.  5iij. 

COPEC'TIO  AROMAT'ICA,  AROMATdC  CONFECTION.  {Pulv.  aromat.  ^vss  ; 
Croci,  in  pulv.  ^ss  ; Syrup  aurant.  corticis,  ^ vj  ; Mellis  despumat. 
5ij.)  Aromatic  confection  possesses  the  excitant  virtues  of  the  in- 
gredients that  enter  into  its  composition,  and  is  adapted  for  cases  in 
which  a carminative  is  needed.  It  is  adapted,  also,  as  a vehicle  for 
the  exhibition  of  certain  tonics  — such  as  the  subcarbonate  of  iron. 
Its  dose  is  from  9ss  to  5j* 

Cinnamon  enters  into  the  composition  of  Acidum  sulphuricum 
aromaticum,  Confectio  aromatica,  Pulvis  aromaiicus.,  Spiritus  lai)an~ 
dul(2  compositus^  Syrupus  rhei  aromaticus,  Tinctura  catechu^  and 
Vinuni  opii  of  the  Pharmacopoeia  of  the  United  States. 

2.  AN!  SUM.  — AN'ISE. 

An' ise  or  An' iseed  is  the  fruit  of  Pimpinel'la  Ani'sum,  Sex.  Syst. 
Pentandria  Digynia  ; Nat.  Ord.  Umbelliferm  ; a native  of  the  Le- 
vant and  Egypt,  but  cultivated  in  many  parts  of  Europe,  and  occa- 
sionally in  the  gardens  of  this  country.  Germany  and  Alicant  ex- 
port a large  quantity  of  the  aniseed,  which  is  used  in  commerce. 
The  Spanish  variety,  commonly  called  Alicant  aniseed,  is  smaller  and 
ofaj)aler  grayish-yellow  than  the  rest,  and  is  the  most  esteemed. 
The  shape  of  all  the  varieties  is  oblong-ovate. 

The  odour  is  aromatie  and  familiar  ; and  the  taste  sweetish,  warm, 
and  grateful. 

Its  medical  properties  are  dependent  upon  the 
O LEUM  ANl'Sl,  OIL  OF  ANTSE,  — which  is  obtained  from  the  seeds  by 


442 


SPECIAL  EXCITANTS. 


distillation.  Its  odour  is  like  that  of  the  vegetable ; taste  pungent 
and  bitter,  sweetish,  and  colour  very  pale-yellow.  It  congeals  at  a 
temperature  of  50°  Fahrenheit,  and  is  soluble,  in  all  proportions,  in 
alcohol ; but  spirit,  whose  specific  gravity  is  0.84,  dissolves  only 
0.42  of  its  weight. 

The  oil  of  anise  of  the  British  shops  is  imported  from  Germany 
and  the  East  Indies,  andjs  used  in  considerable  quantity,  — duty 
having  been  paid,  in  the  year  1839,  on  1544  lbs.  (Pereira.)  The 
Oleum  Badiani  or  Oil  of  Star  anise  {Illicium  anisatum)^  which  has 
the  smell  and  taste  of  the  oil  of  anise,  is  said  to  be  sometimes  sub- 
stituted for  it.  It  is  imported  into  this  country  from  the  East  Indies. 

The  oleum  anisi  is  an  officinal  preparation  in  the  Pharmacopoeia 
of  the  United  States,  and  enters  into  the  composition  of  the  Syrupus 
Sarsaparillce  Compositus  and  Tinctura  Opii  Camphorata, 

The  medical  virtues  of  anise,  as  of  all  the  aromatics,  are  gratefully 
excitant,  and  carminative.  It  is  rarely  used,  however,  except  in 
cases  of  flatulent  colic  in  children,  or  as  a corrigent  to  medicines 
which  are  apt  to  cause  tormina.  The  dose  of  the  powder  is  twenty 
or  thirty  grains  or  more ; that  of  the  volatile  oil,  from  to  tt^xv, 
dropped  on  sugar,  or  rubbed  up  with  it,  and  water,  or  camphor 
water. 

The  infusion  — aniseed  tea  — is  occasionally  taken  sweetened,  in 
cases  of  tormina ; but  it  is  not  so  effectual  as  the  oil. 

Aniseed  water  may  be  made  extemporaneously  by  diffusing  the  oil 
through  water  by  the  aid  of  sugar,  or  of  carbonate  of  magnesia;  and, 
in  the  latter  case,  filtering  through  paper. 

3.  CARUM.  — CAR'AWAY. 

Caraway  is  the  fruit  of  Carum,  Ca’rui;  Sex.  Syst.  Pentandria 
Digynia ; Nat.  Ord.  Umbelliferm  — a native  of  Europe,  which 
grows  in  meadows  and  pastures,  and  is  naturalised  in  England,  and 
cultivated  in  the  gardens  of  this  country. 

Caraway  seeds  are  of  an  ovate  oblong  figure,  and  striated  surface. 
Their  odour  is  aromatic  and  peculiar  ; taste  warm,  spicy  and  grateful. 
Their  medical  properties  are  wholly  dependent  upon  the 

O'LEUl  CARI,  OIL  OF  CAR'AWAY,  which  is  obtained  from  the  seeds  by 
distillation;  and,  accordingly,  the  virtues  are  yielded,  as  in  the  case 
of  anise,  to  both  alcohol,  and  — to  a less  degree  however  — to 
water. 

The  medical  virtues  of  Caraway  are  the  same  as  those  of  anise. 
The  dose  of  the  dried  seeds,  powdered,  is  from  a scruple  to  a drachm ; 
that  of  the  oil  from  one  to  ten  drops.  The  latter  is  often  added  to 
cathartic  pills  and  pow’ders  to  correct  their  nauseating  and  griping 
tendency. 

Caraway  seeds  are  used  in  considerable  quantity  on  the  continent 
of  Europe,  for  seasoning  bread,  cheese,  and  other  articles  of  food; 
and  they  are,  sometimes,  baked  in  cakes,  to  which  — in  the  opinion 


CARDAMOMUM. 


443 


of  perhaps  most  persons  — they  communicate  an  agreeable  flavour, 
and,  at  the  same  time,  gently  excite  the  digestive  function  to  greater 
activity. 

The  seeds  form  part  of  the  Spiritus  Juniperi  Compositus,  and 
Tinctura  SenncB  et  Jalapce,  of  the  Pharmacopoeia  of  the  United  States. 

4.  CORIAN'DRUM.  — CORIAN'DER. 

Coriander  is  the  fruit  of  Corian' drum  sati’vum^  offid'inal  Cori- 
an'deVj  Sex.  Syst.  Pentandria  Digynia ; Nat.  Ord.  Umbelliferce, 
which  is  said  to  be  a native  of  Tartary,  the  Levant  and  southern 
Europe,  but  has  become  naturalised  in  many  parts  of  Europe,  and  is 
cultivated  for  medicinal  purposes.  It  flowers  in  June,  and  the  fruit 
is  ripe  in  August. 

The  fruit  is  of  about  the  shape  and  size  of  white  pepper.  It  is 
finely  ribbed,  and  may  be  divided  into  two  seeds,  which  are  ad- 
herent by  their  concave  surfaces.  The  smell  is  aromatic,  and  cha- 
racteristic, and  is  dependent  upon  a volatile  oil,  which  is  separable 
by  distillation  with  water. 

Coriander  possesses  all  the  virtues  of  the  aromatics.  It  is  scarcely 
ever  given  alone  ; but  is  employed  as  a corrigent  to  other  remedies. 
It  has  been  considered  well  adapted  to  correct  the  griping  qualities 
of  senna ; and,  accordingly,  it  enters  into  the  composition  of  the  in- 
fusion of  senna ; but  its  place  might  be  taken  with  equal  advantage 
by  any  of  the  other  aromatics.  It  forms  part  of  the  Confectio  Sennce^ 
the  Infusum  Gentiance  Compositum,  the  Infusum  Sennce,  the  Tinctura 
Rhei  et  Sennce,  and  the  Tinctura  Sennce  et  Jalapce  of  the  Pharma- 
copoeia of  the  United  States. 

5.  CARDAMO'MUM.  — CAR'DAMOM. 

Cardamom  or  Cardamom  seed  is  the  fruit  of  Alpin'ia  Cardamo'- 
rnum^  Elettaria  Cardamomum  of  Maton,  the  true  or  officinal  car- 
damom'. Sex.  Syst.  Monandria  Monogynia  ; Nat.  Ord.  ScitaminccE, 
— a native  of  the  mountainous  part  of  the  coast  of  Malabar.  For- 
merly, there  were  three  varieties  known  by  the  names  lesser.,  middle, 
and  greater  cardamoms  — the  cardamomum  minus,  cardamomum 
medium,  and  cardamomum  majus  — the  fruit  of  congenerous  plants, 
regarding  which  there  was  confusion  both  botanically  and  commer- 
cially. This  confusion  has  been  in  part  cleared  away  by  modern  phar- 
macologists ; as,  however,  the  lesser  cardamom  is  the  only  variety 
recognised  in  the  Pharmacopoeia,  it  alone  will  receive  attention  here, 

The  dried  capsule  of  the  cardamom,  as  we  receive  it,  is  of  an 
ovate,  oblong,  obtusely  triangular  shape,  from  3 to  10  lines  long  ; 
rarely  more  than  three  broad,  which  contains  many  angular,  black- 
ish or  brown  seeds  — the  cardamom  of  the  Pharmacopoeia.  These 
seeds  are  white  internally,  and  have  an  agreeable  aromatic  odour, 
and  an  aromatic,  warm,  pleasant  taste.  Three  varieties,  accord- 
ing to  Dr.  Pereira,  are  met  with  in  commerce,  the  shorts,  short-longs. 


444 


SPECIAL  EXCITANTS. 


and  long-longs^  which  are  represented  in  the  marginal  figure.  When 

subjected  to  analysis  by  Trommsdorff, 
they  were  found  to  contain  an  essential 
oil,  4.6  ; fixed  oil,  10.4  ; a salt  of  po- 
tassa,  combined  with  a*  colouring  matter, 
2.5  ; fecula,  3.0  ; nitrogenous  mucilage 
with  phosphate  of  lime,  1.8;  yellow 
colouring  matter,  0.4  ; and  woody  fibre, 
77.3.  The  virtues  are  dependent  upon 
the  volatile  oil.  The  properties  of  car- 
damom do  not  differ  from  those  of  other 

o.  Shorts.  6.  siiort  ioiigs.c.  Long-longs.  rarely  given  alone,  but 

forms  a useful,  and  is  a favourite  adju- 
vant and  corrigent  to  stomachic  and  cathartic  medicines.  It  is  an 
agreeable  and  grateful  aromatic  ; but  is  scarcely  ever  given  alone. 

TIDJCTU'RA  CARMMO'MI,  TINCTURE  OF  CAR'DAMOM.  {Cardam.  cont. 
f.  §iv  ; Alcohol,  dilut.  Oij.  It  may  likewise  be  prepared  by  the  pro- 
cess of  displacement.)  The  dose  of  this  is  from.  f.  5 i,  to  f.  ^iij.  It 
may  be  added  to  tonic  or  cathartic  infusions  or  mixtures. 

Cardamom  enters  into  the  composition  of  the  Extractum  colocyn- 
thidis  compositumj  the  Pulvis  aromaticus,  the  Tinctura  cinnamomi 
composita,  the  Tinctura  gentiancc  composita.^  the  Tinctura  rhei.,  the 
Tinctura  rhei  et  aloes,  the  Tinctura  scnnce  et  jalapce,  and  the  Vinurn 
aloes,  of  the  Pharmacopoeia  of  the  United  States. 


Fig.  62. 


Cardamom. 


6.  CARYOPHYL/LUS. —CLOVES. 

Cloves  are  the  unexpanded  flowers  of  Caryophyl'lus  Aromat'icus  ; 

Sex.  Syst.  Icosandria  Monogynia,  Nat. 
Fig.  63.  Ord.  Myrtaceae ; a native  of  the  Mo- 

luccas ; but  extensively  cultivated  at 
Sumatra,  Mauritius,  Bourbon,  Martini- 
que, St.  Vincents,  &c.  They  are  col- 
lected by  the  hand,  or  separated  from  the 
tree  by  beating  it  with  reeds ; are  re- 
ceived on  cloths  placed  under  the  tree, 
and  dried  by  the  fire,  or  in  the  sun.  The 
quantity  of  this  spice  consumed  in  vari- 
ous ways  is  great.  In  the  year  1839, 
according  to  Dr.  Pereira,  duty  wms  paid 
in  England  on  93,549  lbs. 

The  supply  of  the  United  States  is  de- 
rived chiefly  from  the  West  Indies,  and 
the  European  colonies  in  Guiana.  'Those 
from  the  East  Indies  — the  Amhoyna 
and  Bencoolen  Cloves  — are  the  best, 
being  the  largest,  plumpest,  and  most  oily.  The  Cayenne  are  the 
least  valued. 


FOENICULUM. 


445 


Cloves  resemble  a small  nail  with  a notched  head  — hence  the 
name,  from  the  French  clou,  ‘ a nail.’  Their  colour  is  a deep  brown  ; 
odour  strong,  aromatic,  and  peculiar ; taste  acrid  and  pungent. 
They  were  found,  by  Trommsdorff,  to  be  composed,  in  the  100  parts, 
of  volatile  oil,  18  ; almost  tasteless  resin,  6 ; a peculiar  kind  of 
tannin,  4 ; gum,  13  ; woody  fibre,  28  ; and  water,  18.  Unques- 
tionably, their  active  properties  are  dependent  upon  the  volatile  oil 
— O'LEijM  CARYOPIIYL'Ll,  — which  is  in  the  materia  medica  list  of  the 
Pharmacopoeia  of  the  United  States,  being  obtained  from  cloves,  on 
the  large  scale,  in  this  country, — from  seven  to  nine  pounds  of 
cloves  yielding  about  one  pound  of  oil.  (Wood  and  Bache.)  The 
oil  of  cloves,  as  procured  by  distillation  and  repeated  cohobation,  is 
of  a reddish-brown  colour,  and  heavier  than  water. 

The  properties  of  cloves  are  similar  to  those  of  cinnamon  and  other 
aromatics,  — and  the  essential  oil  is  used  in  the  same  cases  as  the 
stronger  essential  oils. 

The  dose  of  the  powdered  cloves  is  from  five  to  ten  grains ; of  the 
oil,  from  Tt\^ij  to  rr^vi.  Water  does  not  extract  all  their  virtues,  so 
that  the  Infusum  Caryophylli  of  the  pharmacopoeias  is  not  so  strongly 
aromatic  and  excitant,  as  the  quantity  of  the  spice  employed  might 
lead  to  expect.  All  the  properties  are  extracted  by  alcohol ; yet  the 
tincture  is  not  officinal  in  the  Pharmacopoeias  of  Great  Britain  and 
Ireland,  or  of  this  country.  It  is  contained,  however,  in  the  Codex 
Medicamentarius  of  Paris.  {Caryophyll.  ; Alcohol,  dilut.  §iv). 

Oil  of  cloves,  diluted  with  olive  oil,  has  been  used  as  an  embro- 
cation in  hooping  cough  ; but  it  possesses  no  virtues  as  a rubefacient 
over  other  essential  oils  of  equal  strength. 

mwmi  CARYOPHYLLI,  INFU'SION  OF  CLOVES.  {Caryophyll.  cont.,  Jij  ; 
Aquae  bullient.  Oj.)  The  dose  of  this,  as  an  aromatic,  is  f.  5iss  to 

Cloves  enter  into  the  composition  of  the  Spiritus  Lavandulce  com- 
positus,  the  Syrupus  Rhei  composifus,  and  the  Vinum  opii  of  the 
Pharmacopoeia  of  the  United  States. 

7.  FCENIC^LUM.  — FENNELSEED. 

Fennelseed  are  the  fruit  of  Fcenic'ulum  vulga're — Sex.  Syst.  Pen- 
tandria  Monogynia  ; Nat.  Ord.  Umbelliferae,  a native  of  the  south 
of  Europe,  Italy,  Portugal,  &c.,  but  cultivated  in  the  gardens  of  the 
United  States.  The  whole  plant  possesses  the  odour  of  the  seeds  ; 
but  they,  alone,  are  officinal. 

They  are  of  an  ovate  shape  ; fragrant  odour  ; and  warm,  sweet, 
and,  to  most  persons,  agreeably  aromatic  taste.  Their  virtues  are 
dependent  upon  an  essential  oil,  which  is  separated  by  distillation 
— the  O'LEUM  FIENIC'ULI.  The  seeds  contain  about  2.5  per  cent.  Pe- 
reira states,  on  private  information,  that  19  cwt.  yield  78  lbs.  of  oil. 
It  congeals  below  50^  of  Fahrenheit,  and  its  s.  g.  is  0.997.  That 
which  is  used  in  the  shops  of  the  United  States  is  imported. 

VOL.  I. — 38 


446 


SPECIAL  EXCITANTS. 


AQUA FOICTLl,  FENNEL  AVATER,  has  been  admitted  into  the  last  edition 

of  the  Pharmacopoeia 


Fig.  64. 


of  the  United  States.  It 
is  rarely  used  except  as  a 
carminative  in  the  bowel 
aflfections  of  infancy.  It 
may  be  made  by  rubbing 
the  oil  with  carbonate  of 
magnesia,  then  adding 
water,  and  filtering  through 
paper,  as  in  the  case  of 
cinnamon  water.  Boiling 
water,  however,  extracts 
the  essential  properties, 
and  Fennel  tea  is  a com- 
mon preparation  as  a do- 
mestic carminative. 

The  dose  of  the  powdered 

Foeniculum  vulgare.  Seeds  is  from  9j  tO  5j  ] that 

of  the  oil  from  xxii)  to  n^xv. 
Fennelseed  enter  into  the  composition  of  the  Spiritus  junipen 
compositus  of  the  Pharmacopoeia  of  the  United  States. 


8.  MENTHA  PIPERFTA.  — PEP'PERMINT. 

Peppermint^  Sexw  Syst.  Didynarnia  Gymnospermia  ; Nat.  Ord. 
Labiatee  ; is  indigenous  in  Great  Britain,  and  is  found  in  various 
parts  of  Europe,  and  in  Asia  and  Africa.  It  has  also  been  intro- 
duced into  this  country,  and,  in  some  parts  of  it,  is  largely  cultivated 
on  account  of  its  volatile  oil.  It  is  a perennial,  but  the  cultivators 
have  observed,  that,  in  order  to  maintain  its  flavour  in  perfection, 
it  is  necessary  to  transplant  the  roots  every  three  years. 

It  is  cut  for  medical  use  in  August,  about  the  period  of  the  de- 
velopment of  the  flowers. 

The  odour  of  peppermint  is  strong,  and,  to  most  persons,  agreea- 
ble ; the  taste  is  pungent  and  aromatic,  and  it  produces  a sensation 
of  coldness  in  the  mouth.  Its  virtues  are  essentially  dependent  upon 
volatile  oil,  which  rises  on  distillation  with  water,  along  with  an 
appreciable  portion  of  camphor.  Its  constituents  are  like  those  of 
lavender. 

Like  other  aromatics,  peppermint  communicates  its  virtues  to  hot 
water,  but  less  completely  than  to  alcohol. 

Peppermint  is  much  employed  as  an  aromatic  excitant  and  car- 
minative, — in  popular  practice  more  perhaps  than  any  of  the  others, 
— as  well  as  to  correct  the  operation  of  cathartic  and  other  agents, 
or  to  mask  the  taste  of  nauseous  medicines. 

It  may  be  given  in  the  form  of  infusion  — Peppermint  tea  — 
which  is  a common  domestic  remedy,  but  is  not  officinal.  The  offi- 
cinal preparations  are  the  following: 


MONAIIDA. 


447 


O LEUM  MENTM  PIPERl  TyE,  OIL  OF  PEPTERMINT,  obtained  by  cUstilling 
the  fresh  herb  with  water,  is  distilled  in  considerable  quantity  in 
this  country  ; the  amount  yielded  by  the  plant  varying  according  to 
the  season,  — a warm  and  dry  season  being  the  most  favourable. 
The  largest  produce  in  Great  Britain  is  said  to  be  three  drachms  and 
a half  of  oil  from  two  pounds  of  the  fresh  herb,  — the  smallest  about 
a drachm  and  a half  from  the  same  quantity.  (Brande.)  It  has  a 
strong  odour  like  that  of  the  plant ; an  acrid,  very  hot,  and  biting 
taste,  with  a peculiar  sensation  of  coldness ; it  is  of  a greenish  yel- 
low colour  ; and  of  a specific  gravity,  according  to  some,  from  0.907 
to  0.920,  according  to  others,  0.899, 

As  an  excitant  aromatic  and  carminative,  it  is  taken  in  the  dose 
of  one  to  five  drops,  on  sugar,  dissolved  or  not  in  water. 

TINCTU'RA  O'LEI  MENTIIl  PIPERITA,  TINCTURE  OF  OIL  OF  PEPTERMINT. 
[01.  menth.  piperit.  f.  Jij  5 Alcohol.  Oj.)  This  tincture — long 
known  and  used  under  the  name  of  Essence  of  Peppermint  — is 
used  in  the  same  cases  as  the  volatile  oil.  Dose,  10  to  20  drops  on 
sugar. 

AQUA  MENTHJ  PIPERITAS,  PEPTERMINT  WATER.  This  water  may  be  dis- 
tilled from  the  herb,  fresh  or  dried  ; but,  in  the  United  States  Phar- 
macopceia,  it  is  directed  to  be  made  like  the  Aqua  Cinnamomi  (p. 
441),  by  rubbing  half  a fluidrachm  of  the  oil  with  half  a drachm  of 
the  carbonate  of  magnesia^  adding  gradually  two  pints  of  distilled 
water and  filtering. 

Peppermint  water  possesses,  in  a certain  degree,  the  properties  of 
the  plant,  but  it  is  chiefly  used  as  a vehicle  for  other  remedies.  Dose, 
f.  §i  to  5iij. 

TROCHISTI  MENTHT  PIPERPTJl,  TROCHES  OF  PEPTERMINT.  [01.  menth. 
piperit.  f.  fv  ; Sacchar.  in  pulv.  ; Mucilag.  tragacanth.  q.  s.,  to 
be  divided  into  troches  weighing  ten  grains  each.)  Peppermint 
lozenges  are  used  as  a gentle  carminative,  but  they  are  rarely  pre- 
scribed by  the  physician. 

9.  MENTHA  VIR'IDIS.  — SPEARMINT. 

Spearmint,  occupying  botanically  the  same  place  in  the  Sexual 
System  and  the  same  Natural  Order  as  the  last,  has  similar  medi- 
cal virtues  and  composition,  but  it  is  not  so  agreeable,  although  by 
some  considered  more  so.  It  is  cultivated  in  the  gardens  of  this 
country  for  its  oil ; and  flowers  in  August. 

OLEUM  MENTHTl  VIR'IDIS.  OIL  OF  SPEARMINT— TINCTU'RA  O'LEI  MENTHiE 
VIR'IDIS,  TINCTURE  OF  OIL  OF  SPEARMINT,  Essence  of  Spearmint,  and 
AQUA  mmWM  VIR'IDIS,  SPEARMINT  WATER,  are  officinal  in  the  Pharma- 
copoeia of  the  United  States. 

10.  MONAR'UA  — HORSEMINT. 

Monar'da  PunctoJta;  Sexual  System,  Diandria  Monogynia ; 


448 


SPECIAL  EXCITANTS. 


Nat.  Ord.  Labiate,  is  an  indigenous  plant,  which  grows  on  light 
gravelly  or  sandy  soils,  from  New  Jersey  to  Louisiana,  and  flowers 

from  June  to  September. 
The  whole  herb  is  oflBci- 
nal  in  the  Pharmacopoeia 
of  the  United  States.  Its 
smell  is  aromatic  ; taste 
warm,  pungent  and  bit- 
terish. 

Like  the  other  mints  its 
properties  are  dependent 
upon  volatile  oil,  which 
may  be  separated  by  dis- 
tillation with  water.  An 
infusion  — horsemint  tea 
— is  a domestic  remedy 
as  a carminative  ; but  is 
rarely  employed  by  the 
practitioner. 

O LEUM  MOMR'D^,  Oil  OF 
HORSEMINT,  distilled  from 
the  fresh  herb  is  of  a 
reddish  amber  colour,  of 
an  odour  like  that  of  the 
plant,  and  a warm,  very 
pungent  taste.  It  is  a 
powerful  rubefacient,  when 
applied  to  the  cutaneous 
surface,  exciting  even  ve- 
sication ; hence,  it  has 
been  used  in  low  fevers, 
chronic  pains,  cholera  in- 
fantum, and  other  diseases  in  which  rubefacients  are  considered  to 
be  indicated. 

Dose,  as  an  excitant,  should  it  be  desirable  to  administer  it  in- 
ternally, two  to  three  drops  on  sugar. 

Monar'da  Coccin'ea  has  similar  virtues. 


11.  HEDEO'MA.  — PEN'NYROYAL. 

Hedeo'ma  Pulegio'ddes,  or  Cundla  Pulegioi’des ; Sex.  Syst.  Dian- 
dria  Monogynia;  Nat.  Ord.  Labiate,  is  indigenous  in  the  United 
States,  in  all  parts  of  which  it  is  common  in  dry  grounds  and  pas- 
tures, — its  presence  being  very  perceptible  from  the  strong  odour 
exhaled  by  it.  It  is  not  the  same  as  the  European  pennyroyal, 
which  is  Mentha  Pule' gium^  yet  the  virtues  of  the  two  are 
identical. 

Hedeoma  has  an  agreeable  aromatic  odour,  and  a warm  pungent 
taste,  resembling  that  of  mint.  Like  the  mints,  its  medical  pro- 


ORIGANUM. 


449 


perties  are  wholly  dependent  upon  an  essential  oil  0 
DEO'Mil,  which  is  sepa- 


IIE- 


rated  by  distillation 
with  water.  They  are 
readily  yielded  to  hot 
water ; and  -pennyroyal 
tea  is  a common  do- 
mestic remedy,  sup- 
posed to  favour  the  ad- 
vent of  the  menses,  but 
possessing  no  special 
virtues  of  an  emmena- 
gogue  kind. 

Like  the  aromatics 
in  general,  infusion  of 
pennyroyal  is  given  as 
a carminative  in  all 
cases  in  which  a gently 
excitant  agency  on  the 
stomach  is  needed.  — - 
When  taken  hot,  like 
all  the  aromatics,  it 
promotes  perspiration. 

The  oil,  which  has 
a light  yellow  colour, 
and  the  smell  and  taste 
of  the  herb,  and  is  of 
the  specific  gravity 
0.948,  is  used  in  the 
same  cases  as  the  aro- 
matic oils  in  general. 
The  dose  is  from  two 
to  ten  drops. 


Fig.  66. 


Hedeoma  pulegioides. 


12.  ORIG'ANUM. 


Orig'anum  vulga're,  or  cormnon  Mar'joram  ; Sex.  Syst.  Didyna^ 
mia  Gymnospermia  ; Nat.  Ord.  Labiatae,  is  a native  of  America, 
Europe  and  Asia.  In  the  United  States,  from  Pennsylvania  to  \ir- 
ginia,  it  grows  along  the  roadsides,  and  In  dry  stony  fields  ; and  is 
in  flower  from  June  to  October.  It  is  rarely,  however,  employed 
medicinally.  Its  medical  properties,  which  are  dependent  upon  an 
essential  oil  separable  by  distillation  with  water,  are  the  same  as 
those  of  the  mints,  and  the  aromatic  herbs  in  general ; but  it  is  very 
rarely  used. 

O'LEM  ORIG'ANL  OIL  OF  ORIG'ANUM,  Oil  of  Mar'joram,  Oil  of  Thyme, 
when  recently  and  properly  prepared,  is  of  a yellowish  colour  ; but 
if  too  much  heat  be  used  in  the  distillation,  it  is  said  to  be  reddish, 
and  to  acquire  the  same  hue  by  age.  It  has  the  smell  of  the  plant, 
38^ 


450 


SPECIAL  EXCITANTS. 


and  a hot  very  acrid  taste.  Two  hundred  weight  of  the  plant  is 
said  by  Mr.  Brande  to  yield,  on  the  average,  one  pound  of  oil.  It  is 
scarcely  ever  given  internally  ; being  generally  employed  as  an  exter- 
nal irritant  in  the  same  cases  as  the  oleum  monardae  ; and  in  carious 
odontalgia,  — a drop  being  introduced  on  cotton  or  lint  into  the  hol- 
low of  the  tooth. 

The  oil  enters  into  the  composition  of  the  Linimentum  Saponis 
Camphoratum  of  the  Pharmacopoeia  of  the  United  States. 

13.  MYRIS'TICA.  — NUTMEG. 

Nutmegs  are  the  kernels  of  the  fruit  of  Myris'tica  Moscha'ta  ; 
Sex.  Syst.  Dioecia  Monadelphia  ; Nat.  Ord.  Myristicaceae,  a na- 
tive of  the  Moluccas.  The  fruit  is  round 
or  oval,  of  the  size  of  a small  peach.  The 
outer  covering,  which  is  at  first  thick  and 
fleshy,  and  abounds  in  an  austere  astrin- 
gent juice,  afterwards  becomes  dry  and 
coriaceous  ; and,  separating  into  two 
valves  from  the  apex,  discloses  a yellow- 
ish or  red  reticulated  membrane  or  arillus, 
which  is  the  mace  of  commerce,  closely 
investing  a thin  brown  shell,  which  con- 
tains the  kernel  or  nutmeg. 

The  fruit  is  gathered  by  the  hand,  and 
the  outside  envelope  is  rejected.  The 
mace  is  then  carefully  separated,  flattened, 
and  dried  in  the  sun. 

The  nuts  are  dried  in  the  sun  or  in 
ovens,  and  exposed  to  smoke,  until  the  kernel  rattles  in  the  shell. 
They  are  then  broken  open,  and  the  kernels  having  been  removed, 
and  steeped,  for  a short  time,  in  a mixture  of  lime 
and  water,  to  protect  them  from  the  depredations  of 
insects,  they  are  cleaned,  and  packed  in  chests  for 
exportation.  The  nutmegs  are  very  liable  to  the  at- 
tacks of  an  insect  called  the  nutmeg  insect. 

Nutmegs  are  imported  into  England  from  the  In- 
dian Archipelago,  either  directly,  or  indirectly  by  the 
Cape  of  Good  Hope,  or  Holland.  In  1838,  accord- 
ing to  Dr.  Pereira,  duty  was  paid  on  114,093  lbs. 
Into  this  country,  they  are  brought  either  directly 
from  the  East  Indies,  or  indirectly  through  England 
and  Holland.  They  are  occasionally  exported  in 
small  quantities  from  the  West  Indies,  into  which  their  culture  has 
been  introduced. 

Nutmegs  have  a fragrant  aromatic  odour,  and  an  agreeable  pun- 
gent taste  ; are  of  a roundish  or  oval  shape  ; streaked  ; of  a grayish 
colour,  yielding  readily  to  the  knife  or  the  rasp,  but  not  easily  pul- 


Fig.  68. 


surrounded 
by  the  mace. 


Fig.  67. 


Myristica  inoschata. 


MYRISTICA. 


451 


verisable.  On  analysis  by  N.  E.  Henry,  they  were  found  to  con- 
tain volatile  oil ; red  fat,  soluble  in  alcohol ; yellow  fat,  insoluble 
in  alcohol ; alcoholic  extractive  : amidin,  and  ligneous  fibre,  with 
lime. 

The  volatile  oil — O'LEUM  MYRIS'TICJI — procured  by  submitting 
nutmegs  to  distillation  with  water,  is  always  imported  from  the 
East  Indies.  It  is  colourless  or  pale  yellow,  and  has  the  smell 
and  taste  of  nutmeg.  • By  agitation  with  water,  it  separates  into 
two  oils,  — the  one  lighter,  the  other  heavier  than  water. 

The  Oleum  Myristicce  of  the  former  Pharmacopceia  of  the  United 
States,  and  of  two  of  the  British  Pharmacopoeias,  is  the  expressed  oil, 
improperly  called  oil  of  mace^  inasmuch  as  mace  yields  a volatile 

011  on  distillation  with  water,  similar  to  the  volatile  oil  of  nutmeg. 

The  expressed  oil  is  prepared  by  beating  nutmegs  to  a paste, 

which  is  inclosed  in  a bag,  exposed  to  the  vapour  of  water,  and 
expressed  between  heated  plates.  The  nutmeg  is  said  to  yield  10  or 

12  per  cent,  of  this  oil. 

The  best  is  imported  from  India  in  stone  jars.  An  inferior  kind 
is  in  oblong  cakes,  covered  with  the  leaves  of  some  plant.  It  is 
composed,  according  to  Dr.  Pereira,  of  tallow-like  oil,  7 ; yellow  oil, 

; volatile  oil,  §.  An  artificial  preparation  is  said  to  be  sometimes 
substituted  for  the  genuine  oil.  It  is  made  by  mixing  together 
various  fatty  matters,  as  suet,  palm  oil,  spermaceti,  wax,  lard,  &c., 
adding  some  yellowish  or  brownish  colouring  substance,  and  giving 
flavour  to  the  mixture  by  the  volatile  oil  of  nutmeg. 

This  expressed  oil  is  never  used  internally ; and  rarely  as  a gentle 
local  excitant ; and  therefore  it  has  been  properly  left  out  in  the  last 
edition  of  the  Pharmacopceia  of  the  United  States. 

Nutmeg  possesses  the  virtues  of  all  the  aromatic  excitants,  of  which 
it  is  one  of  the  most  agreeable  ; and,  therefore,  most  used.  It  is  a 
well  known  spice  to  give  flavour  to  alimentary  substances,  and  is 
used  therapeutically  for  the  same  purpose,  as  well  as  to  mask  the 
flavour  of  other  less  agreeable  agents.  It  is  said  to  have  proved 
narcotic  in  India,  when  administered  in  large  doses  ; but,  practically, 
no  such  effects  are  ever  witnessed  from  it  here.  Dr.  Pereira  asserts, 
that  he  is  acquainted  with  a case  in  which  the  narcotic  effects  of  a 
whole  nutmeg  were  several  times  experienced. 

Either  nutmeg  or  mace,  whose  medical  properties  are  analdgous, 
may  be  given,  in  the  dose  of  from  to  ^ss,  in  powder  obtained  by 
grating:  or  the  oleum  myristicae  may  be  employed  in  the  dose  of 
TTij  to  in.x. 

SPIR'ITUS  MYRIS'TICI,  SPIRIT  OF  NUTMEG.  {Myristic.conixxs.  §ij ; Alcohol, 
dilut.  cong.  Aquce^  Oj.  Distil  a gallon.)  It  possesses  the  virtues  of 
nutmeg ; but  is  chiefly  used  as  an  agreeable  adjunct  to  other  agents. 
Dose,  f.  ^j  to  f.  3iij. 

Nutmeg  enters  into  the  composition  of  the  Spiritus  Lavandulce  com- 
positus,  the  Syrupus  Rhei  aromaticus^  the  Trochisci  Crefce,  and  the 
Trochisci  Magnesice  of  the  Pharmacopoeia  of  the  United  States. 


452  SPECIAL  EXCITANTS. 

14.  SAS'SAFRAS  RADI/CIS  CORTEX.— BARK  OF  SAS'SAFRAS  ROOT. 

Laurus  Sas'safras^  Sex.  Syst.  Enneandria  Monogynia  ; Nat.  Ord. 
Lauraceee,  (Lindley,)  is  an  indigenous  tree,  common  throughout  the 
United  States,  which  blooms  in  the  Middle  States  in  the  beginning 
of  May.  The  wood  is  used  in  Europe,  whither  it  is  sent  in  billets; 
but  it  is  not  much  employed  in  this  country,  — the  bark  of  the  root 
being  the  officinal  portion  given  as  an  excitant. 

The  bark,  as  found  in  the  shops,  is  generally  in  small  irregular 
pieces,  invested,  at  times,  with  a brownish  epidermis;  of  a reddish 
colour;  very  brittle,  and  presenting,  when  freshly  broken,  a lighter 
colour  than  that  of  the  exposed  surfaces.  Its  odour  is  fragrant,  and 
has  been  compared  to  that  of  fennel ; and  the  taste  aromatic  and 
sweetish.  The  virtues  are  dependent  upon  a volatile  oil,  which  is 
separable  by  distillation  with  water.  They  are  yielded  readily  to 
water,  so  that  the  infusion  is  occasionally  employed  as  an  excitant. 
Sassafras  tea  has,  indeed,  been  used  in  some  parts  of  the  country 
in  place  of  Chinese  tea.  Flavoured  with  milk  and  sugar,  it  is  sold 
at  day-break  in  the  streets  of  London,  under  the  name  of  Saloop. 

The  medical  properties  of  sassafras  are  those  of  the  Lauracese  in 
general.  It  is  rarely,  however,  used  as  an  excitant.  It  is  employed, 
mainly  as  an  adjunct  to  diet  drinks  in  syphilis  and  syphiloid  affec- 
tions ; but,  in  this  respect,  has  by  no  means  the  reputation  it  enjoyed 
formerly. 

O'LEDM  SAS'SAFRAS,  OIL  OF  SAS'SAFRAS.— the  oil  obtained  by  distillation 
with  water,  — is  one  of  the  heaviest  of  the  volatile  oils  ; s.  g.  1.094. 
The  bark  yields  from  1.25  to  2 per  cent.  It  is  of  a yellow  colour, 
turning  reddish  by  age,  and  has  the  odour  of  the  sassafras,  and  a 
warm,  pungent,  aromatic  taste.  By  agitation  with  water,  it  separates 
into  two  oils ; one  lighter,  the  other  heavier,  than  water. 

Sassafras  oil  possesses  the  virtues  of  all  the  aromatic  oils  ; but  it  is 
rarely  given.  Dose,  rr^j  to  tt\,x. 

Sassafras  bark  enters  into  the  composition  of  the  Decoctum  Sarsa- 
parillce  compositum,  of  the  Pharmacopoeia  of  the  United  States  ; and 
sassafras  oil  into  that  of  the  Syrupus  Sarsaparillce  compositus. 

15.  LAVAN'DULA.  — LAV'ENDER. 

Lavan'dula  vera^  Common  or  Garden  Lavender;  Sex.  Syst.  Didy- 
namia  Gymnospermia;  Nat.  Ord.  Labiatse,  is  a native  of  southern 
Europe,  but  is  largely  cultivated  in  Great  Britain,  and  also  in  the 
gardens  of  this  country,  where  it  flowers  in  August.  All  the  plant 
possesses  the  same  properties ; but  the  flowers  or  spikes  are  alone 
officinal,  which  should  be  cut  when  they  begin  to  bloom. 

Lavender  flowers  are  of  a bluish-gray  colour  ; and  have  a fragrant, 
agreeable  odour,  and  a warm  bitterish  taste.  When  subjected  to 
analysis,  they  afford  volatile  oil,  resin  [?],  tannic  acid,  a bitter  prin- 
ciple, and  woody  fibre  ;•  but  the  oil  is  the  active  constituent.  It  is 
obtained  by  distilling  the  flowers  with  water. 

The  medical  virtues  of  lavender  are  those  of  an  excitant  like  other 


ROSMARINUS. 


453 


aromatics,  but  as  its  taste  is  not  as  agreeable  as  man  of  them,  it 
is  rarely  prescribed  alone.  It  is  more  frequently  used  as  an  ad- 
junct to  other  remedies  administered  in  cases  of  nervous  debility  ; 
or  to  articles  whose  disagreeable  odour  it  is  desirable  to  conceal 
or  mask. 

O LEUM  LAYANTULdt],  OIL  OF  LAV  ENDER,  is  of  a lemon  colour,  has  a fra- 
grant odour  — that  of  the  flower  — and  a warm  taste.  Its  specific 
gravity  varies  from  0.877  to  0.905  — the  lightest  oil  being  the 
purest.  The  oil  obtained  from  the  whole  herb  has  a specific  gravity 
0.9206,  but  the  odour  of  the  oil  is  considerably  deteriorated  when 
the  stalks  and  leaves  are  used  in  the  distillation.  One  pound  of 
oil  is  obtained  from  fifty  to  seventy  pounds  of  the  flowers. 

Like  the  other  essential  oils,  it  is  soluble  in  alcohol  of  a certain 
specific  gravity.  That  of  0.830  dissolves  it  in  all  proportions  ; 
that  of  0.887  dissolves  only  42  per  cent. 

The  oil  is  chiefly  used  as  a perfume  ; but  occasionally  it  is  em- 
ployed as  a carminative,  especially  in  nervous  headache,  hysteria, 
&c.,  in  the  dose  of  from  one  to  five  drops  on  sugar. 

SPIR'ITUS  LAVAN'DIM,  SPIRIT  OF  LAV  ENDER,  recent,  tfeij  ; 

Alcohol,  cong.  ; Aqucc  Oij  ; distil  a gallon.)  This  preparation  is 
rarely  employed  alone.  It  is  chiefly  used  for  the  formation  of  other 
officinal  compounds.  It  is  often  made  by  adding  the  oil  of  lavender 
to  rectified  spirit. 

SPIR'ITUS  LAVAN  DULA  COMPOS'ITUS,  COMPOUND  SPIRIT  OF  LAV'ENDER,  Com- 
pound  tincture  of  lavender  ^Lavender  drops  ^ Red  lavender  drops.  {Spirit, 
lavandul.  Oiij  ; Sp.  rosmarin.  Oj  ; Cinnamom.  cont.  ; Caryophyll. 
cont.  5ij  ; Myristic.  cont.  ^ss;  Santal.  resur.  5iij.)  This  is  one  of 
the  most  common  remedies  prescribed  by  the  practitioner  ; and  is  em- 
ployed by  the  unprofessional  in  nervous  and  hysterical  affections, 
and  in  cases  of  faintness  or  depression.  It  is  also  added,  occa- 
sionally, to  other  excitants  and  to  tonic  mixtures.  The  dose  is  from 
f.  5j  to  f.  ^ij,  dropped  on  sugar. 

Lavender  water  — as  it  is  termed  in  the  shops  — is  a solution  of  oil 
of  lavender,  and  other  scents  in  spirit.  It  is  chiefly  used  as  a 
perfume. 

16.  ROSMARINUS.  — ROSE'MARY. 

Rosman'nus  officinalis  or  common  rose'mary : — Sex.  Syst.  Dian- 
dria  Monogynia ; Nat.  Ord.  Labiatse,  an  evergreen  shrub,  grows 
spontaneously  in  southern  Europe,  and  Asia  Minor,  and  is  cultivated 
in  the  gardens  of  Great  Britain  and  this  country.  The  tops  or  flower- 
ing summits  are  the  officinal  portion.  Their  odour  is  fragrant  and 
grateful  ; taste,  aromatic  and  bitterish. 

The  medical  virtues  of  rosemary,  which  are  dependent  upon 
essential  oil,  are  communicated  partially  to  water,  wholly  to  alco- 
hol. They  are  those  of  the  labiate  plants  in  general,  — as  the 


454 


SPECIAL  EXCITANTS. 


mints,  many  of  which  have  been  supposed  to  be  possessed  of  em- 
menagogue  properties  ; but  probably  only  through  the  excitant  in- 
lluence  of  the  essential  oil.  It  is  rarely  given  internally  ; and  when 
it  is  so,  it  is  usually  as  an  adjunct.  Dose  of  the  powder,  gr.  x 
to  5ss. 

O LEUM  ROSMARI'NI,  OIL  OF  ROSEMARY,  is  procured  from  rosemary  by 
distillation  with  water.  The  fresh  leaves  afford  the  oil  in  consider- 
able quantity,  yet  great  discrepancy  exists  as  to  the  precise  amount: 
some,  asBaume,  cited  by  Wood  and  Bache,  stating  it  at  26  per  cent.  ‘ 
others,  as  Mr.  Brande,  holding,  that  one  pound  of  the  fresh  herb  yields 
about  a drachm  of  the  oil.  The  former  estimate  is  evidently  an 
exaggeration.  Oil  of  rosemary  is  transparent  and  colourless,  having 
a very  fragrant  odour,  and  taste  like  that  of  the  plant.  Its  specific 
gravity  is  about  0.85.  When  long  kept,  it  deposits  a substance 
identical  with  camphor. 

It  is  rarely  prescribed  internally,  although  calculated  to  act  as  a 
nervine  as  well  as  the  Oleum  lavandulse.  It  is  generally  associated 
with  other  substances  as  a topical  excitant,  and  hence  forms  part  of 
various  rubefacient  liniments. 

If  administered  internally,  it  may  be  in  the  same  dose  as  the  other 
aromatic  volatile  oils,  — three  to  ten  drops. 

SPIR1TUS  ROSMARI'NI,  SPIRIT  OF  ROSE'MARY.  {01.  Rosmarin.  5ij ; Alcohol. 
cong. ; Aquce^  Oj  ; distil  a gallon.)  It  is  rarely  employed  internally, 
but  is  added  to  lotions  and  liniments,  as  the  Linimentum  Saponis  ; 
and  to  one  compound  excitant  tincture — the  Spiritus  Lavandulcc 
compositus. 

The  Queen  of  Hungary'^s  water  is  formed  extemporaneously  by  a 
mixture  of  spirit  of  lavender  and  spirit  of  rosemary,  [Sp.  Lavand.  f. 
§xii ; Sp.  Rosmarin.  f.  §iv.)  It  is  chiefly  used  as  a perfume  ; and, 
also,  as  an  excitant  in  the  same  cases  as  the  compound  spirit  of  la~ 
vender.,  — for  example,  in  nervous  depression,  fainting,  &c.  It  makes, 
likewise,  a good  excitant  liniment. 

Oil  of  rosemary  enters  into  the  composition  of  the  Linimentum  Sa- 
ponis camphoratum,  and  the  Tinctura  Saponis  camphor ata  of  the 
Pharmacopoeia  of  the  United  States. 

17.  GAULTHE'RIA.— PARTRIDGE  BERRY. 

Gaiilthe'ria  procum'benSy  Sex.  Syst.  Decandria  Monogynia;  Nat. 
Ord.  Ericem,  is  indigenous  from  Canada  to  Georgia,  growing  in 
mountainous  tracts,  in  large  beds,  and  in  dry,  barren  and  sandy 
plains,  beneath  the  shade  of  shrubs  and  trees,  and  especially  of  other 
evergreens.  It  has  various  names  in  different  parts  of  the  United 
States,  such  as  deerherry,  teaberry,  wintergreen^  and  mountain  tea., 
berried  tea.,  grouseberry,  &c.;  some  of  the  names  being  owing  to  the 
circumstance,  that  the  fruit  is  a favourite  article  of  food  with  par- 
tridges, deer,  and  grouse.  It  flowers  from  May  to  September. 


JUNIPERUS. 


455 


The  leaves,  which  are  the  olficinal  part  of  the  plant,  owe  their 
virtues  to  an  essential  oil,  — O'LEUM  GAULTHE  'RIiE — separable  by  distilla- 
tion with  water. 


They  contain, 
also, tannic  acid, 
which  gives  them 
marked  astrin- 


^ency. 


The  oil 


Fig.  69. 


has  a brownish 
yellow  colour,  a 
sweetish,  pun- 
gent, peculiar 
taste,  and  an 
agreeable  and 
peculiar  odour. 

It  is  heavier  than 
any  of  the  essen- 
tial oils  ; its  spe- 
cific gravity  be- 
ing 1.17. 

The  medical 
properties  of 
gaultheria,  are 
those  of  the  aro- 
matics in  gene- 
ral. It  possesses 

at  the  same  time  a slight  astringency,  which  may  adapt  it  to  certain 
cases  of  diarrhoea  ; but  it  is  chiefly  used,  on  account  of  its  agreeable 
flavour,  as  an  adjunct  to  other  medicines. 

Hot  water  extracts  its  virtues,  and,  therefore,  it  may  be  used  in 
the  form  of  infusion  or  tea.  The  oil  is,  however,  most  commonly 
employed.  It  is  an  ingredient  of  the  Syrupus  Sarsaparillce  composi- 
tus  of  the  Pharmacopoeia  of  the  United  States. 


Gaultheria  procuinbens. 


18.  JUNIP'ERUS.  — JU'NIPER. 


Ju'niper  or  ju^niper  berries  is  the  fruit  of  Junip'erus  commu'nis ; 
Sex.  Syst.  Dioecia  Monadelphia  ; Nat.  Ord.  Coniferae  — a native 
of  the  north  of  Europe,  but  introduced  into  this  country,  in  some 
parts  of  which  it  has  become  naturalised.  In  the  Pharmacopoeias  of 
Europe,  not  only  the  berries,  but  the  tops  and  wood  are  officinal  ; 
but  as  the  berries  possess  all  the  virtues,  they  alone  are  officinal 
in  the  Pharmacopoeia  of  the  United  States.  They  are  round,  of 
about  the  size  of  a pea,  and  more  or  less  shrivelled  ; of  a blackish 
purple  colour,  and  covered  with  a glaucous  bloom.  The  taste  is 
sweetish,  with  a terebinthinate  flavour. 

The  property  on  which  their  virtues  are  dependent  is  a volatile 
oil,  separable  by  distillation  with  water;  and  these  are  communicated 


456 


SPECIAL  EXCITANTS. 


to  water  and  to  alcohol.  They  are,  consequently,  excitant,  yet 

neither  they,  nor  any  of  the  prepara- 
Fig.  70.  tions,  are  much  exhibited  as  excitants. 

They  are  chiefly  prescribed  as  diu- 
retics, under  which  class  some  of  the 
preparations  are  mentioned.  The 
essential  oil  is  the  only  one  that  needs 
comment  here. 

OTEUM  JUNIFERI,  OIL  OF  E'NIPER. 
The  oil,  used  in  this  country,  is 
chiefly  obtained  from  Europe.  Its 
odour  is  similar  to  that  of  turpen- 
tine ; its  taste  acrid,  hot,  and  like 
that  of  the  juniper ; and  its  colour 
light  greenish  yellow  ; s.  g.  0.911. 
It  is  said  to  be  adulterated  occa- 
sionally with  oil  of  turpentine,  which 
renders  it  of  considerably  less  spe- 
cific gravity. 

The  dose  of  the  oil,  as  an  excitant, 
is  from  five  to  fifteen  drops. 

Juniper  berries  enter  into  the  com- 
position of  the  Spiritus  Juniperi  com- 
Juniperus  communis.  positus  of  the  Phariuacopoeia  of  the 

United  States. 


19.  LIMO'NIS  CORTEX. — LEMON  PEEL. 

The  outer  rind  of  the  fruit  of  Citrus  Limo'num,  Lemon  tree;  Sex. 
Syst.  Polyadelphia  Icosandria ; Nat.  Ord.  Aurantiacese,  is  officinal 
in  most  of  the  pharmacopceias.  The  lemon  tree  has  been  considered 
a native  of  Asia.  It  is  now,  however,  naturalised  throughout  the 
whole  of  the  south  of  Europe,  in  northern  Africa,  Asia  Minor,  and 
in  many  of  the  more  temperate  regions  of  the  tropics.  It  is  largely 
cultivated  in  Spain,  Portugal, Italy,  Sicily,  and  southern  France  ; and 
we  observe  it,  occasionally,  fostered  and  protected  in  our  own  gar- 
dens. The  lemons  that  are  used  in  England  are  imported  chiefly 
from  Spain,  Portugal,  Italy,  and  the  Azores  ; those  used  in  this 
country  come  mainly  from  the  West  Indies  and  the  Mediterranean. 

Lemon  peel  has  a fragrant  well  known  odour,  and  a warm,  aro- 
matic, bitter  taste.  By  drying,  it  loses  a good  a deal  of  its  warmth 
and  odour.  It  yields  by  expression  or  distillation  an  essential  oil, 
O'LEUM  LIMO'NIS,  which  is  obtained  on  the  large  scale,  but  not  by  the 
apothecary,  and  is,  therefore,  placed  in  the  Materia  Medica  list  of 
the  Pharmacopoeia  of  the  United  States. 

The  virtues  of  lemon  peel  are  yielded  to  water  and  to  alcohol. 


AURANTII  CORTEX. 


457 


Lemon  peel  is  indebted  to  its  essential  oil  for  its  excitant  virtues. 
It  forms  an  agreeable  adjunct  to  excitant  or  tonic  infusions,  but  is 
rarely  given  alone.  It  enters  into  the  composition  of  the  Infuswm 
Aurantii  of  the  Edinburgh  and  Dublin  Pharmacopoeias,  and  of  the 
Infusum  Gentiance  Compositum  of  the  Dublin  and  London  Pharma- 
copoeias. 

O'LEUM  LIMO'NIS,  OIL  OF  LEMONS.  This,  as  remarked  above,  is  obtained 
either  by  expression  or  distillation.  In  the  former  process,  the  rind 
is  grated  from  the  fruit,  and  then  expressed  in  hair  sacks.  The  oil  is 
suffered  to  remain  at  rest  until  it  deposits  some  of  its  impurities,  after 
which  it  is  decanted  and  filtered.  Thus  obtained,  it  is  turbid,  and, 
owing  to  its  containing  mucilaginous  matter,  does  not  keep  so  well  as 
that  obtained  by  distillation,  but  its  flavour  is  said  to  be  more  plea- 
sant and  sweet.  It  possesses,  in  a high  degree,  the  flavour  of  the 
fruit.  It  is  of  a pale  yellow  colour,  and  is  said  to  be  sometimes 
adulterated  with  fixed  oil,  and  with  alcohol.  The  former  adultera- 
tion can  be  detected,  as  in  the  case  of  volatile  oils  in  general,  by 
its  leaving  a stain  on  paper,  when  dropped  on  it  and  evaporated 
by  a gentle  heat : the  latter  is  known  by  agitation  with  water  pro- 
ducing milkiness. 

Oil  of  lemons  has  the  same  excitant  properties  as  other  volatile  oils  ; 
and,  like  them,  may  be  given  as  a carminative  dropped  on  sugar, 
or  rubbed  up  with  it.  It  is  generally,  however,  used  as  a perfume  to 
cover  the  objectionable  odour  of  other  substances.  Its  employment 
in  certain  cases  of  conjunctivitis  has  been  referred  to  in  an  early  part 
of  this  volume. 

Oil  of  lemons  is  a constituent  of  the  Unguentum  Veratri  alhi  of 
the  Pharmacopoeia  of  the  United  States. 


20.  O'leum  Berga'mit,  Oil  of  Bergamot'  — the  volatile  oil  of  the 
rind  of  the  fruit  of  Citrus  Limet'ta,  Citrus  Limetta  Berga'miu?n^ 
Citrus  Berga'mia^  or  Bergamot  Citrus^  which  is  cultivated  in  the 
south  of  Europe  — is  in  the  Materia  Medica  list  of  the  Pharmacopoeia 
of  the  United  States.  It  is  imported  from  the  south  of  Europe.  It 
is  only  used  as  a scent  to  cover  nauseous  substances;  and,  with  this 
view,  it  is  made  to  form  part  of  the  Unguentum  Sulphuris  compositum 
of  the  Pharmacopoeia  of  the  United  States. 

21.  AURAN'TII  CORTEX.— ORANGE  PEEL. 

Orange  peel  is  the  outer  rind  of  the  fruit  of  Citrus  vulga'ris^ 
Bigarade  or  Bitter  Orange  Tree  ; and  of  Citrus  Auran'tiumj  Com- 
mon  or  Sweet  Orange  Tree  ; Sex.  Syst.  Polyadelphia  Icosandria  ; 
Nat.  Ord.  Aurantiacem.  The  orange  is  a native  of  Asia.  It 
grows  wild  in  various  parts  of  northern  Africa  and  Eastern  Asia,  and 
is  cultivated  in  the  warmer  parts  of  the  globe  almost  every  where. 
In  the  southern  portions  of  the  United  States,  it  is  extensively  cul- 
voL.  I.— 39 


458 


SPECIAL  EXCITANTS. 


tivated,  but  the  fruit  is  chiefly  brought  from  the  West  Indies,  the 

Western  Isles,  and  the  south  of 
Europe. 

Various  parts  of  the  orange  tree, 
besides  the  peel  of  the  fruit,  are 
used  in  medicine.  The  leaves 
have  a slightly  bitter  taste,  and  are 
aromatic  and  tonic.  They  contain 
a volatile  oil,  which  is  obtained 
by  distillation,  and  constitutes  the 
Essence  de  Petit  Grain , of  the 
French  Pharmaciens.  The  flowers 
have  an  agreeable  odour,  depend- 
ent upon  essential  oil  — which  has 
been  termed  JVero/i  Oil ; 550  pounds 
of  the  flowers  yielding  about  an 
ounce.  It  is  used  altogether  in  perfumery.  The  distilled  water 
of  the  flowers,  called  Orange-flower  Water ^ is  much  prescribed  by 
the  French  as  a nervine.  The  immature  oranges,  which  fall  off, 
are  aromatic  and  bitter,  and  are  used  for  flavouring  cura^oa ; hence 
they  are  called  Curagoa  Oranges.  When  smoothed  by  a lathe,  they 
form  the  best  issue  peas  of  the  shops.  The  rind  of  the  fruit,  like 
that  of  the  lemon,  yields  a volatile  oil,  which  resembles,  in  odour, 
the  rind  itself ; but  it  is  directed  to  be  separated  by  distillation  by 
many  of  the  colleges. 

Orange  peel  possesses  similar  properties  to  lemon  peel,  and  is 
applicable  to  the  same  cases.  It  is  an  aromatic  excitant,  and  is 
prescribed  as  an  adjunct  to  tonic  and  excitant  infusions,  chiefly 
with  the  view  of  communicating  flavour  to  them.  The  bark  of 
the  bitter,  or  Seville  orange,  is  to  be  preferred  where  it  is  advised 
as  a tonic  adjunct  or  adjuvant.  It  is  never,  perhaps,  given  in 
substance. 

CONFEC'TIO  AURANTIl,  CONFECTION  OF  ORANGE  PEEL.  (Aurant.  cort.  recent, 
[separated  by  grating]  p^j  ; Sacchar.  fbiij.)  This  confection  is  not 
much  used.  It  possesses  the  aromatic  virtues  of  orange  peel,  and 
may  be  employed  as  a vehicle  for  bitter  powders,  or  for  some  of  the 
preparations  of  iron,  as  the  subcarbonate. 

SYR'UPUS  AURAN'TII  COR'TICIS,  SYRUP. OF  ORANGE  PEEL  {Aurant.  cort. 
contus.  §ij ; Aqucehullient.  Oj  ; Sacchar.  tbiiss.)  This  syrup  is  chiefly 
employed  to  give  an  agreeable  flavour  to  excitant  and  tonic  infusions: 
f.  5iij  of  it  may  be  added  to  f.  §vi  of  any  of  these.  It  enters  into 
the  composition  of  the  Confectio  aromatica  of  the  Pharmacopceia  of 
the  United  States. 

22.  CAM'PHORA.  — CAMPHOR. 

Camphor  is  a peculiar  concrete  substance,  derived  from  Lauras 


Fig.  71. 


Citrus  Aurantium. 


CAMPHORA. 


459 


Cam'pliora^  and  purified  by  sublimation, 
essential  oil,  and  yet  it  agrees  in  many  of 
its  properties  with  it.  It  differs,  how- 
ever, in  its  solidity  at  ordinary  temperatures, 
and  in  its  not  being  converted  into  resin  by 
the  oxygen  of  the  air,  or  by  nitric  acid. 

Laurus  CamJphora — Sex.  Svtst.  Enne- 
andria  Monogynia,  Nat.  Ord.  Lauracese  — 
is  a native  of  Cliina,  Japan  and  Cochin 
China,  and  is  said  to  have  been  introduced 
from  Japan  into  Java.  In  China,  it  is  af- 
firmed, the  chopped  branches  are  steeped 
in  water,  and  afterwards  boiled,  until  the 
camphor  begins  to  adhere  to  the  stick  used 
in  stirring.  The  liquid  is  then  strained, 
and,  on  standing,  the  camphor  concretes : 
alternate  layers  of  finely  powdered  earth,  and  of  this  crude  camphor, 
are  then  placed  in  a copper  basin,  to  which  another,  inverted,  is 
luted.  Heat  is  now  applied  and  the  camphor  sublimes.  In  Japan, 
the  process  is  somewhat  different ; the  roots  and  wood  are  chopped 
up,  and  boiled  with  water,  in  an  iron  vessel,  to  which  an  earthen 
head  containing  straw  is  adapted.  On  the  application  of  heat,  the 
camphor  sublimes  and  condenses  on  the  straw. 

Two  kinds  of  crude  camphor  occur  in  commerce,  one  called  tub 
camphor j from  being  imported  in  tubs.  It  comes  from  Batavia,  but 
is  said  to  be  the  produce  of  Japan  ; it  is,  also,  called  Dutch  camphor^ 
and  Japan  camphor.  The  other  kind  — common  crude  camphor^  China 
camphor^  Formosa  camphor^  is  imported  from  India,  in  square  chests. 
It  is  chiefly  produced  in  the  island  of  Formosa.  This  crude  camphor 
is  in  small  grains,  or  granular  masses,  of  a dirty  white  colour,  but  is 
never  found  in  the  shops.  It  is  refined  by  sublimation.  Formerly, 
all  the  refined  camphor  was  obtained  from  abroad  ; but  now  the  pro- 
cess is  effected  on  a large  scale  in  this  country,  and  the  camphor  is 
considered  equal  to  any  that  was  formerly  imported.  The  crude 
camphor  is  mixed  with  a small  proportion  of  quicklime,  and  exposed, 
in  a glass  or  earthenware  vessel,  in  a sand-bath,  to  a gradually  in- 
creased heat,  by  which  it  is  melted,  and  ultimately  converted  into 
vapour  which  is  condensed  in  a suitable  vessel.  (Wood  & Bache.) 

The  refined  camphor  of  the  shops  has  the  form  of  the  vessel  in 
which  the  sublimation  has  been  accomplished,  and  is,  therefore, 
generally  in  the  form  of  large  hemispherical  cakes ; convex  on  one 
side,  concave  on  the  other,  and  perforated  in  the  centre.  It  is  of  a 
white  colour,  semi-pellucid,  brittle  yet  easily  pulverisable,  and  of  a 
crystalline  texture.  Its  odour  is  strong,  peculiar,  and  fragrant ; taste 
bitterish  and  aromatic,  accompanied  by  a sensation  of  coldness.  It 
evaporates  in  the  air  at  ordinary  temperatures ; and  in  closed 
vessels,  as  in  the  bottles  in  the  shop  of  the  apothecary,  which  are 
exposed  to  light,  it  evaporates,  and  crystallises  on  the  sides.  It  is 


It  is  not  properly  an 
Fig.  72. 


Laurus  Camphora. 


460 


SPECIAL  EXCITANTS. 


soluble  to  a slight  extent  only  in  water ; but  is  soluble  in  alcohol, 
ether,  the  oils,  both  fixed  and  volatile,  &c.  If  water  be  added  to  the 
solution  in  alcohol,  the  camphor  is  immediately  precipitated.  Its 
specific  gravity  is  0.9857. 

There  are  few  articles  of  the  Materia  Medica,  regarding  the  effects 
of  which  on  the  animal  economy  there  has  been  greater  diversity 
of  sentiment.  In  respect,  however,  to  its  excitant  action  in  certain 
doses,  there  is  but  little  disagreement;  and  it  is  this  action  only,  that 
has  to  be  considered  here.  When  it  is  applied  endermically,  it 
excites  pain,  and  if  held  in  the  mouth  occasions  heat,  redness  and 
other  signs  of  hyperaemia  in  the  mucous  membrane  of  the  mouth ; 
and  when  swallowed  in  substance,  the  sensations  experienced  in  the 
epigastric  region  are  similar  to  those  induced  by  the  essential  oils  in 
general. 

It  is  asserted  by  some,  that  depression  has  preceded  the  excitation 
induced  by  it ; but  although  the  author  has  administered  it  in  nume- 
rous cases  with  the  view  of  carefully  observing  its  effects,  he  has 
never  witnessed  this  preceding  sedation.  In  regard  to  its  deleteri- 
ous effects  on  the  nervous  system  when  taken  in  large  doses,  and  the 
discordant  views  in  relation  thereto,  opportunity  may  be  afforded  to 
treat  in  another  place. 

It  may  be  remarked  here,  that  whilst  strangury  has  been  ascribed 
to  it  by  some  ; it  is  the  main  remedy  on  which  many  others  depend 
in  cases  of  strangury,  — in  that  especially  which  is  induced  by  can- 
tharides.  The  author  has  neither  observed  the  influence  of  camphor 
in  one  case  nor  in  the  other.  He  is  not  disposed  to  place  much 
value  upon  it  as  an  excitant  in  those  cases  in  which  it  has  been  so 
much  extolled  by  many.  It  is  chiefly  in  adynamic  and  long  pro- 
tracted fevers  that  it  has  been  prescribed  ; but  almost  always  associ- 
ated with  some  other  agent,  as  with  opium,  where  the  object  has 
been  to  allay  restlessness  and  irritation,  and,  at  the  same  time,  to 
induce  — as  it  has  been  conceived — ^ some  tendency  towards  the 
skin; — or  with  carbonate  of  ammonia,  where  the  prostration  has 
been  more  considerable.  In  none  of  these  cases,  perhaps,  does  the 
practitioner  look  solely  to  the  excitant  agency  of  the  camphor;  but 
rather  to  that  narcotic  influence  which  has  been  ascribed  to  it  by 
some. 

W^hatever  properties  it  has  appeared  to  possess  as  a diaphoretic  — 
and  the  belief  in  which  has  led  to  its  use  in  other  diseases,  as  chro- 
nic rheumatism,  gout,  &c.  — have  been  probably  owing  to  its  gently 
excitant  agency  ; but  farther  reference  has  been  made  to  this  subject 
under  another  head. 

Of  old,  camphor  was  esteemed  to  be  possessed  of  antaphrodisiac 
properties,  and  many  of  the  moderns  have  ascribed  to  it  the  same. 
Esquirol  is  stated  to  have  cured  by  it  hysteric  nymphomania  ; and 
F.  Le  Gros  affirms,  that  he  found  it  the  most  active  remedy  he  could 
use  for  blennorrhagic  erections  and  chordee.  As  an  antaphrodisiac 
the  author  has  had  no  experience  with  it. 


CAMPHORA. 


461 


Wonderful  j^virtues  have  been  ascribed  to  it  of  late  by  M.  Ras- 
pail  — a fanciful  therapeutist  — who,  for  years,  has  been  in  the 
habit  of  smoking  and  inhaling  it  under  the  form  of  cigar,  both  day 
and  night.  He  also  placed  under  his  bolster  a certain  quantity  of 
purified  camphor;  in  consequence  of  which,  he  says,  his  nights,  in- 
stead of  being  agitated,  were  passed  in  calm  and  uninterrupted 
sleep.  Whenever  he  awakes  he  chews  from  three  to  four  grains  at 
least,  which  he  afterwards  swallows  with  a little  water.  In  the 
course  of  the  night  the  quantity  sometimes  amounts  to  as  much  as 
12  grains.  In  the  day  time,  he  takes  a similar  dose ; and  em- 
ploys frictions  with  camphorated  spirit  on  rising  and  going  to  bed,  or 
whenever  he  experiences  the  least  lassitude  of  spirit  or  the  slightest 
exhaustion  of  body.  “ Under  this  treatment,”  he  says,  “ I have  — 
so  to  speak  — shed  the  old  skin  of  disease.  I have  grown  young 
again  in  physical  and  moral  strength.  I am  more  disposed  to  la- 
bour, and  am  less  inconvenienced  than  ever  by  it.”  Raspail’s  ciga- 
rettes have  been  much  used,  but  it  need  hardly  be  said  with  no  such 
advantages  as  he  has  experienced. 

Camphor  forms  part  of  many  of  the  officinal  and  other  liniments, 
of  different  pharmacopoeias  and  formularies,  as  well  as  of  those  of  do- 
mestic use.  In  such  cases,  it  is  usually  combined  with  other  excitants. 

The  medium  dose  of  camphor,  in  substance,  is  generally  stated  at 
from  five  to  ten  grains ; which  may  be  given  rubbed  up  with  sugar, 
or  — what  is  preferable — in  the  form  of  pill.  An  objection  has 
been  urged  against  the  pilular  form  — that  as,  in  this  state,  the  cam- 
phor is  with  difficulty  dissolved  in  the  gastric  fluids,  it  may  float  on 
the  top,  and  be  apt  to  excite  nausea,  or  pain  and  uneasiness  at  the 
upper  orifice  of  the  stomach.  (Wood  & Bache).  The  author  has 
never  witnessed  any  of  these  results,  which  probably  occurred,  in 
the  cases  where  they  have  been  met  with,  in  consequence  of  the 
dose  having  been  large.  At  the  same  time,  with  the  opinion,  which 
he  possesses  of  the  value  of  camphor  as  an  excitant,  he  is  disposed 
to  place  as  much  reliance  on  an  ordinary  dose  of  the  Aqua  cam- 
phorce  of  the  pharmacopoeia,  which  contains  a very  small  amount  of 
camphor,  as  on  a larger  dose  administered  in  pill  or  powder. 

As  an  antaphrodisiac  it  has  been  given  in  the  dose  of  a drachm. 

AHUACAM'PHORiE,  CAMPHOR  WATER.  {Camphor,  Alcohol.  Mag- 
nesicB  carbonat.  ; Aquce  destillat.  Oij.)  The  alcohol  is  added  to 
break  down  the  cohesion  of  the  camphor,  and  the  carbonate  of  mag- 
nesia facilitates  its  solution.  Each  fluidounce  of  the  water  is  com- 
puted to  contain  three  grains  of  camphor.  The  usual  dose  is  from 
f.  ^ss  to  f.  more. 

TINCTC'RA  CAM'PHORiE,  TINCTURE  OF  CAMPHOR.  {Camphor . ) Alco- 

hol. Oij.)  This  is  the  ^‘camphorated  spirit  of  icinef  of  the  older 
pharmacopoeias.  It  is  rarely  given  internally.  If  desirable,  how- 
ever, from  10  to  60  drops  may  be  rubbed  up  with  sugar,  and  water 
be  added  to  make  a draught.  Should  the  water  be  added  without 
39* 


462 


SPECIAL  EXCITANTS. 


this  precaution,  the  greater  part  of  the  camphor  would  be  separated. 
Water  must,  consequently,  be  regarded  as  an  incompatible. 

Tincture  of  camphor  is  generally  employed  as  an  excitant  lini- 
ment in  sprains  and  bruises,  in  cases  of  deep-seated  pains,  of  a 
rheumatic  or  neuralgic  kind,  in  which  it  is  desirable  to  excite 
revulsion  on  the  surface  ; and  to  modify  the  nutritive  actions  of  a 
part,  as  in  cases  of  tumours. 

LINIMENJUM  CAMP'HORJ],  CAMPHOR  LIN  IMENT.  {Camphor.  §ss ; Olei 
oliv(2,i.  §ij.) 

LINIMEN'TUM  SAPO'NIS  CAPIIORA'TUM.  CAMPH  ORATED  SOAP  LIN'IMENT,  OPO- 
DEL'DOC,  [Sapon.  vulgar.  §iij;  Camphor.  3 j ; 01.  rosmarin..,  01. 
origan,  aa  f.  ; Alcohol.  Oj.) 

TINCTURA  SAPO'NIS  CAMPHORA'TA,  CAMPH'ORATED  TINCTURE  OF  SOAP, 
Soap  Liniment.  {Sapon.  in  rasur.  §iv;  Camphor.  Jij  ; 01.  rosma- 
rin.  f.  3ss  ; Alcohol.  Oij.) 

These  various  liniments  are  employed  under  the  same  circum- 
stances as  the  Tinctura  carnphoree.  They  are  better  adapted,  how- 
ever, for  prolonged  friction,  by  reason  of  the  admixture  of  soap,  or 
oil,  or  both;  and,  consequently,  are  generally  prescribed  where  the 
object  is  to  discuss  tumours  ; or  to  occasion  the  taking  up  of  any 
solid  or  fluid  deposition. 

Camphor  forms  part  of  the  Tinctura  Opii  Camphorata  of  the  Phar- 
macopoeia of  the  United  States. 

23.  CANEL'LA. 

Canella  is  the  bark  of  Canel'la  alha^  Laurel-leaved  Canella^  or 
Wild  Cin’namon  ; Sex.  Syst.  Dodecandria  Monogynia  ; Nat.  Ord. 
Meliacese  ; — Guttiferae  (Jussieu),  a tree,  from  ten  to  fifty  feet  high, 
which  is  indigenous  in  the  West  India  Islands,  and  the  neighbour- 
ing continent  of  America. 

Canella  of  the  shops  is  the  inner  bark  of  the  stem  and  branches, 
occurring  in  quills,  but  sometimes  in  flat  pieces  of  considerable  size. 
It  is  of  a pale  orange-yellow  colour,  and  of  an  odour  and  taste  in- 
termediate between  those  of  cloves  and  cinnamon.  It  is  confound- 
ed at  times  with  Winter"* s Bark  (q.  v.),  and  hence  has  been  called 
spurious  Winter"’ s Bark.  It  certainly  resembles  it  in  taste,  but  not 
much  in  appearance. 

When  subjected  to  analysis,  canella  yields  volatile  oil,  which  is 
its  active  ingredient ; a little  bitter  extractive,  which  communicates 
to  it  what  tonic  property  it  possesses ; besides  other  matters  of  less 
importance.  Alcohol  extracts  all  its  virtues. 

Canella  possesses  the  ordinary  excitant  virtues  of  the  aromatic 
'barks,  and  may  be  prescribed  in  the  dose  of  gr.  x to  5ss.  It  is  rarely, 
however,  given  alone  ; but  is  added  to  cathartic  and  tonic  agents, 
to  act  as  a corrigent  to  the  former,  and  an  adjuvant  to  the  latter.  It 
enters  into  the  composition  of  the  Pulvis  Alo’es  et  Canellce  of  the 
Pharmacopoeia  of  the  United  States, 


CALAMUS. 


463 


24.  WIN/TERA.  — WINTER’S  BARK. 

This  article  is  in  the  secondary  list  of  the  Pharmacopoeia  of  the 
United  States.  It  is  the  bark  of  Win’tera  Aro-  Fig.  73. 

mat'ica^  Drymis  Win'teri,  Winter"^ s Bark  Tree  ; 

Sex.  Syst.  Polyandria  Tetragynia  ; Nat.  Ord. 

Magnoliacese  ; an  evergreen  tree,  which  is  in- 
digenous along  the  straits  of  Magellan,  Chili, 

Peru,  and  New  Grenada. 

The  bark  of  the  shops  is  in  quills  or  rolled 
pieces  ; of  a pale  yellowish  or  dull  reddish- 
gray  colour  externally,  with  red  elliptical 
spots.  Internally,  it  is  of  a reddish-brown 
colour  ; whilst  the  inner  surface  of  canella,  with 
which  it  has  been  confounded,  is  of  a pale  co-  winteri.^ 

lour.  Like  canella  its  main  constituent  is  volatile  oil  ; but  unlike 
it,  it  contains  tannic  acid  and  oxide  of  iron. 

Its  medical  virtues  are  essentially  those  of  canella,  than  which  it  is 
much  less  used.  Dose  of  the  powder,  gr.  x to  5SS. 

25.  CAL'AMUS.  — SWEET  FLAG. 

Calamus,  of  the  Pharmacopoeia  of  the  United  States,  is  the  rhizoma 
of  Ac'orus  Ca'lamus ; Sex.  Syst.  Hexandria  Monogynia ; Nat.  Ord. 
Aroidese  ; — Acoraceae  (Lindley)  — an  indigenous  plant,  which  grows 
abundantly  in  this  country,  in  low,  damp  places,  and  along  the  sides 
of  ditches  and  streams,  and  flowers  in  May  and  June.  It  also  grows 
abundantly  in  many  parts  of  Europe  and  Asia. 

The  roots,  as  they  are  met  wdth  in  the  shops,  are  of  variouslengths, 
flattened,  and  of  the  breadth  of  the  fingers  ; they  are  of  a yellowish- 
brown  colour,  and,  on  the  under  surface,  there  are  numerous  dark 
points,  w’hence  the  roots  arise:  the  texture  of  the  rhizoma  is  spongy 
or  corky,  and  the  fracture  short  and  rough. 

The  odour  is  strong  and  rather  fragrant;  the  taste  aromatic, 
warm,  and  bitterish.  On  distillation  with  water,  it  yields  an  essen- 
tial oil  — \he  oleum  calami  aromatici  of  the  shops  — on  which  its 
medical  virtues  essentially  depend;  but  it  is  never  used  in  medi- 
cine. It  is  said  to  be  employed  by  the  wholesale  dealers  in  per- 
fumery, and  to  be  bought  by  snuff-makers,  with  the  view  probably 
of  scenting  snuff. 

In  addition  to  the  essential  oil,  calamus  has  been  found  also  to 
contain  resin  and  extractive,  the  latter  of  which  has  an  acrid  and 
sweetish  taste. 

Calamus  is  not  much  used  in  medicine  ; it  appears,  however, 
to  have  risen  in  estimation  with  the  framers  of  the  Pharmacopoeia 
of  the  United  States,  who,  in  the  last  edition,  (1842),  have  ele- 
vated it  from  the  secondary  to  the  primary  list. 

Its  properties,  being  mainly  dependent  upon  essential  oil,  its 
virtues  are  yielded  to  water  ; and  in  the  form  of  infusion^  [Colam. 
2j  ; Aq.  bullient.  Oj  : dose,  a wine-glassful,)  it  may  be  given  as  a 
stomachic  and  carminative  in  atonic  conditions  of  the  digestive 


464 


SPECIAL  EXCITANTS. 


organs,  — but  it  does  not  seem  to  be  possessed  of  any  virtues, 


Fig.  74.  not  equally  pos- 

sessed by  the 
other  articles  of 
the  class.  A re- 
cent writer,  Dr. 
Pereira,  considers 
it  to  be  especially 
serviceable  in 
gouty  subjects. 

The  dose  of  the 
powder  is  from 
to  sj. 

It  need  scarcely 
be  repeated,  that 
a decoction  is  ob- 
jectionable in 
every  case,  where 
the  medical  pro- 
perties are  de- 
pendent wholly  or 
in  part  on  essen- 
tial oil. 

26.  PIMEN'TA.— 
PIMEN'TO. 

Pimen'tOy  All- 
spice^ or  Jama'ica 
Pepper,  is  the  un- 
ripe berry  of  Myr- 
tus  Pimen’ta,  or 
Euge'nia  Pi- 
men'ta ; Sex. 
Syst.  Icosandria 
Monogynia ; Nat. 
Ord.  Myrtaceae — 
a native  of  the 
West  Indies,  and  particularly  abundant  in  Jamaica,  whence  one  of  its 
names.  It  isa  native  likewise  of  Mexico  and  South  America.  Whenthe 
fruit  has  attained  its  full  size,  but  is  yet  green,  it  is  gathered  and  dried. 

The  quantity  on  which  duty  was  paid  in  England,  in  1S39,  was, 
according  to  Dr.  Pereira,  277,185  lbs. 

The  taste  of  allspice,  which  is  a familiar  spice,  is  pungent, 
slightly  astringent,  and  mixed,  like  the  odour,  which  is  aromatic 
and  resembles  a mixture  of  cinnamon,  nutmeg  and  cloves.  It 
imparts  its  flavour  to  water,  and  all  its  virtues  to  alcohol.  The 
analysis  of  the  berries  by  Bonastre  furnishes  a variety  of  consti- 
tuents, but  those  on  which  the  medical  properties  are  dependent 
are  a volatile  oil — -separable  into  two  oils,  one  lighter  and  the 


PIPER. 


465 


other  heavier  than  water ; and  a green  oil  or  resinous  matter, 
which  has  an  acrid  burning  taste,  and  contributes  to  the  activity 
of  the  pimento.  Except  in  odour,  the  properties  of  the  volatile 
oil  appear  to  be  almost  identical  with  those  of  the  oil  of  cloves. 

Pimento  possesses  the  medical  properties  of  the  other  spices.  It 
is  a warm  aromatic  excitant;  — not  often  administered  alone;  but 
chiefly  used  as  an  adjunct  to  other  medicines,  to  communicate  fla- 
vour, or  to  correct  griping  or  nauseous  properties.  It  is  in  exten- 
sive use  as  a condiment. 

The  dose  of  the  powder  is  from  10  to  40  grains. 

O'LEUM  PlMEN'TTl,  OIL  OF  PIMEN'TO,  is  obtained  by  submitting  allspice, 
bruised,  to  distillation  with  water.  The  allspice,  according  to  Dr. 
Pereira,  yields  about  1.37  per  cent,  of  oil  — heavy  and  light  toge- 
ther. Its  colour  is  reddish-brown  ; its  odour  very  fragrant,  and 
both  that  and  the  taste  are  those  of  the  pimento,  but  in  an  increased  de- 
gree. Its  specific  gravity  is  greater  than  that  of  water,  averaging  1.021. 

It  is  employed  medicinally  in  the  same  cases  as  the  other  aroma- 
tics and  volatile  oils.  Dose  from  irLij  to  ^x. 

Aqua  Pimentce  may  be  formed  with  the  oil  in  the  same  manner  as 
Aqua  Cinnamomi  (q.  v.) 

SPIR'ITUS  PIMENTl,  SPIRIT  OF  PIMENTO.  {Piment.  cont.  §ij ; Alcohol 
dilut.  cong. ; Aquce^  Oj  ; distil  a gallon.)  It  has  the  same  medical 
qualities  as  the  ordinary  aromatic  spirits.  Dose,  f.  5j  to  f.  5iij. 

27.  PIPER.—BLACK  PEPPER. 

The  berries  of  black  pepper  — Piper  nigrum  — Sex.  Syst. 
Diandria  Trigynia  ; Nat.  Ord.  Piperacese, 

(Kimth)  — are  the  only  officinal  pepper  in 
the  Pharmacopoeia  of  the  United  States. 

They  possess,  however,  all  the  virtues  of 
the  class.  The  plant  is  cultivated  in  va- 
rious parts  of  India,  and  the  Islands,  and 
likewise  in  the  West  Indies  ; but  Europe 
and  America  derive  their  main  supplies 
from  Sumatra  and  Java.  In  1840,  the 
quantity  which  paid  duty  on  importation 
into  England  was,  according  to  Dr.  Pe- 
reira, 2,271,174  lbs.  Piper  nigrum. 

The  berries  are  gathered  before  they  are  perfectly  ripe ; and,  on 
being  dried,  become  black  and  wrinkled  ; but  this  applies  only  to 
the  outer  surface  ; which,  when  removed,  leaves  the  white  pepper — 
piper  alhum^  which  is  a more  delicate  spice,  not  containing  the  same 
proportion  of  active  ingredient. 

Pepper-corns  are  of  the  size  of  small  peas,  have  an  aromatic  odour, 
and  a fiery,  pungent  taste,  which  is  dependent  upon  essential  oil. 
Accordingly,  their  virtues  are  yielded  to  alcohol,  and  — in  a less 
degree  — to  water.  On  analysis,  they  have  been  found  to  yield, 


466 


SPECIAL  EXCITANTS. 


1.  Resin  of  Pc})per,  a very  acrid  substance,  possessing  in  a great 
degree  the  acrid  properties  of  the  peppers,  soluble  in  alcohol  and 
ether,  but  not  in  volatile  oils.  2.  Volatile  Oil  of  Pepper' — having 
the  odour  and  taste  of  pepper.  3.  Piperin,  found  in  all  the  peppers, 
and  described  under  the  head  of  Tonics. 

The  medical  properties  of  pepper  are  essentially  those  of  capsicum, 
than  which  it  is  less  acrid.  Like  it,  it  is  extensively  used  as  a con- 
diment. In  atonic  conditions  of  the  stomach,  as  in  the  gouty,  it  is 
occasionally  given  to  check  nausea,  or  to  remove  flatulence,  but  it  is 
not  often  prescribed  — partly,  perhaps,  owing  to  familiarity  with  it 
as  a condiment  constantly  on  the  table  having  prevented  it  from 
receiving  as  much  attention  as  it  otherwise  might  have  done.  It  has 
been  prescribed  occasionally  in  place  of  cubebs  in  gonorrhoea,  and 
the  other  mucous  inflammations  for  which  the  latter  remedy  has  been 
advised. 

A watery  infusion  has  been  found  serviceable  in  relaxed  sore 
throat,  and  it  has  occasionally  been  employed  as  an  excitant  in  pa- 
ralysis of  the  tongue.  Formed  into  an  ointment^  it  has  been  used  in 
tinea  capitis,  and  with  this  view  an  Unguentum  Piperis  Nigri, 
{Adipis^  Ibj  ; Piper,  nigr.  in  pulv.  5iv.)  is  officinal  in  the  Dublin 
Pharmacopoeia,  but  it  has  to  be  employed  with  caution,  and  is  scarcely 
ever  used  on  this  side  the  Atlantic. 

The  dose  of  black  pepper  is  from  gr.  v.  to  gr.  xv.  It  may  be  ad- 
ministered either  in  the  berry  or  in  powder.  In  the  latter  case,  it 
may  be  made  into  pills. 

A nostrum,  called  Ward’s  Paste^  acquired  much  celebrity  in  piles, 
fistulae,  and  chronic  affections  of  the  rectum  ; and,  in  consequence,  a 
substitute  was  introduced  into  the  British  Colleges  under  the  name 
CoNFECTio  Piperis  nigri.  It  has  received  high  testimony  in  its 
favour,  and  would  seem  to  have  been  beneficial  in  diseases  of  the 
lower  part  of  the  bowels,  in  which  an  excitant  is  indicated.  Sir 
Benjamin  Brodie  asserts,  that  it  has  sometimes  proved  successful  in 
severe  cases  of  piles,  by  mixing  with  the  fseces,  and  coming  in  con- 
tact with  the  diseased  parts.  It  consists  of  black  pepper,  elecam- 
pane root,  fennel  seed,  honey,  and  sugar. 

28.  CAPSICUM.  — CAYEN'NE  PEPPER. 

Cayenne  Pepper  is  the  fruit  of  Cap'sicum  an’nuum  ; Sex.  Syst. 
Pentandria  Monogynia;  Nat.  Ord.  Solanese;  — Solanaceae,  (Bindley,) 
— a native  of  the  warmer  regions  of  Asia  and  America,  and  exten- 
sively cultivated  in  Europe  and  this  country.  The  recent  fruit, 
called  Chillies^  is  sold  for  pickling ; and  the  dried  fruit  of  the  drug- 
gists bears  the  same  name. 

There  are  different  varieties  of  capsicum,  which  produce  a fruit 
varying  in  shape  ; but  the  oblong  varieties  are  those  that  are  chiefly 
used  medicinally.  The  fruit,  when  perfectly  ripe,  dried,  and  re- 
duced to  powder,  forms  redpepper  or  Cayenne  pepper . 

The  odour  of  capsicum  is  aromatic  and  pungent ; the  taste  very 


CAPSICUM. 


467 


biting,  hot,  and  aromatic.  Its  virtues,  which  have  been  considered 
to  be  dependent  upon  a peculiar  principle,  called  capsicin,  are  yielded 
to  ether,  alcohol  and  water.  The  following  is  the  analysis  of  Bra- 
connot : — Acrid  oil,  (capsicin,)  1.9  ; wax,  with  red  colouring  mat- 
ter, 0.9  ; brownish  starchy  matter,  9.0  ; peculiar  gum,  6.0  ; animal- 
ised  matter,  5.9  ; woody  fibre,  67.8  ; salts,  (citrate  of  potassa,  6.0  ; 
phosphate  of  potassa,  and  chloride  of  potassium,  3.4  ;)  — 9.4.  — 
Total,  100. 

The  action  of  capsicum,  taken  internally,  is  excitant ; and  when 
applied  to  any  portion  of  the  cutaneous  surface,  it  is  rubefacient,  and, 
consequently,  revellent.  If  taken  in  an  overdose,  it  may  cause  in- 
flammation of  the  stomach;  but  it  is  not  easy  to  conceive,  that  a 
sufficient  quantity  to  produce  this  effect  could  be  readily  taken,  in 
consequence  of  its  acrid  action  upon  the  mouth.  It  is  a well  known 
condiment;  and,  in  the  East  Indies,  is  used  in  very  large  quantities, 
without  any  disagreeable  results.  A friend  of  the  author  has  seen 
one,  who  had  resided  for  a long  time  in  Hindusthan,  eat  it  upon 
bread  and  butter  — the  layer  of  the  pepper  being  as  thick  as  that  of 
the  latter.  In  those  climes,  the  effect  of  the  elevated  temperature  has 
an  injurious  influence  on  the  function  of  innervation  ; digestion  is 
accordingly  imperfectly  performed,  and  excitant  condiments  are 
greatly  indulged  in. 

Capsicum  is  not  often  administered  as  a general  excitant ; but  it 
is  highly  appropriate,  wherever  there  is  defective  impressibility  of 
the  stomach.  In  cases  of  malignant  cholera,  and  in  the  low  stages 
of  fever,  it  is  occasionally  prescribed  by  some ; but  it  is  more  fre- 
quently employed  in  asthenic  dyspepsia  — as  in  that,  which  occurs 
in  atonic  gout,  or  in  the  habitual  drunkard.  It  has,  also,  been  pre- 
scribed in  paralytic  and  lethargic  cases;  but  the  internal  use  of 
excitants  must  be  used  in  such  cases  with  caution,  — for  fear,  that 
the  pathological  condition,  which  is  usually  hemorrhage  into  the 
encephalon,  or  vascular  hyperaemia,  should  be  augmented  by  it.  It 
has  likewise  been  advised  as  an  adjunct  to  sulphate  of  quinia  in 
intermittents,  in  which  there  is  great  want  of  gastric  impressibility. 
It  is  most  commonly,  however,  used  as  a local  excitant,  especially 
in  cases  of  malignant  or  sluggish  sore  throat ; and  its  good  effects  in 
scarlatina  maligna  have  been  deposed  to  by  many  excellent  observers. 
The  author  has  occasionally  seen  asthenic  or  sluggish  sore-throat 
aggravated  by  it;  but,  at  other  times,  benefit  has  resulted. 

In  cynanche  maligna  — including  in  the  term  the  cynanche  of 
scarlatina  maligna  — it  is  given  by  some  internally  at  the  same  time. 
The  following  form  is  one  that  is  often  used  as  a gargle.  ( Capsic. 
in  pulv.  ; Sodii  chlorid.  ^j  ; Jlceti,  f.  §ss  ; Aquce  ferventis,  f.  ^vj. 
Infunde  et  cola.)  In  relaxed  conditions  of  the  throat  or  uvula,  it 
may  be  applied  also  in  the  form  of  tincture  by  means  of  a camel’s 
hair  pencil. 

As  a rubefacient,  capsicum  is  used  wherever  cutaneous  revellents 
are  considered  to  be  indicated,  ^ as  in  the  delirium  or  coma  of 


468 


SPECIAL  EXCITANTS. 


fever;  but  in  such  cases  sinapisms  are  generally  preferred.  It  may 
be  made  into  a cataplasm  in  the  same  manner  as  mustard,  and  be 
applied  to  the  lower  extremities;  or  it  may  be  mixed  with  heated 
spirit,  and  used  as  a lotion.  In  similar  cases,  as  well  as  when  the 
circulation  does  not  go  on  actively  in  the  lower  limbs,  as  shown  by 
cold  feet,  woollen  socks  may  be  dusted  with  the  powder.  In  neu- 
ralgic pains,  the  same  applications  are  often  beneficial ; and  in  the 
cold  stage  of  cholera,  where  frictions  were  indicated,  the  cayenne 
pepper  was  often  added  to  the  ointments  used  for  this  purpose.  It 
formed  a common  adjunct  to  the  Unguentum  hydrargyri. 

The  capsicum  cataplasm  is  not  so  apt  to  vesicate  as  the  sinapism. 

The  dose  of  capsicum  powder  is  from  three  grains  to  ten,  which 
may  be  made  into  pills  with  crumb  of  bread;  or — especially  in 
cases  of  atony  of  the  stomach  — with  extract  of  gentian.  (Pulv. 
capsic.y  Ext.  gentian. aa9j  ; Aquce^  q.  s.;  ut  fiant  pilulse  xij.  Each 
pill  will  contain  about  two  grains  of  capsicum.) 

In  cases  of  cynanche,  the  gargle  before  recommended  may  be 
used,  or  a simple  infusion  of  capsicum.  [Capsic.  in  pulv.  5ss ; 
Aquce  ferventis.^  Oj);  or  a mixture  of  the  tincture  of  capsicum  and 
water.  (Tincturce  capsid,  f.  ^ss;  Aquce,  f.  5viij.) 

TINCTU'RA  CAP'SICI,  TINCTURE  OF  CAYENNE  PEPPER.  (Capsic.  ; Alcohol, 
dilut.  Oij.)  The  dose  of  the  tincture  of  cayenne  pepper  is  from  tt^x 
to  f.  3j  or  more,  in  the  cases  before  mentioned.  It  is  likewise  em- 
ployed occasionally  to  cover  the  taste  of  oil  of  turpentine,  as  well  as 
to  prevent  the  nausea  which  the  oil  might  induce ; and  is  sometimes 
used  as  a rubefacient,  when  evaporated  to  the  consistence  of  an 
extract,  and  spread  over  the  part. 

29.  CUBEB/A.  — CUBEBS. 

Cubebs  are  the  berries  of  Piper  cuheh'a;  Sex.  Syst.  Diandria 
Trigynia;  Nat.  Ord.  Piperaceee.  This  species  of  pepper  is  a native 
of  Java  and  Prince  of  Wales  Island,  but  flourishes,  also,  in  India 
and  Guinea. 

It  is  the  dried  unripe  fruit.  It  resembles  black  pepper,  except 
that  it  is  lighter  coloured,  and  each  pepper-corn  is  furnished  with  a 
short  stalk,  which  has  given  it  the  name  Piper  cauduHum.  Within 
the  hard  shell  is  a spherical  seed,  which  is  whitish  internally,  and 
oily.  The  odour  of  cubebs  is  aromatic;  the  taste  pungent  like 
pepper,  and  camphoraceous. 

The  active  ingredient  of  cubebs  is  the  volatile  oil,  — O'LEUM  CUBEB'jE 
— which  is  separated  by  distillation,  is  officinal  in  the  Pharmaco- 
pceia  of  the  United  States,  and  is  regarded  by  some  as  the  best  and 
most  convenient  preparation  of  cubebs.  (Pereira.)  The  analysis  of 
cubebs  by  Monheim  afforded  the  following  results  — green  volatile 
oil,  2.5;  yellow  volatile  oil,  1.0;  cubehin^  probably  the  same  as 
piperin,  4.5;  balsamic  resin,  1.5;  wax,  3.0;  chloride  of  sodium,  1.0; 
extractive,  6.0;  lignin,  65.0;  loss,  15.5.  — total,  100.00. 


CUBEBA. 


469 


The  action  of  cubebs  on  the  economy  is,  in  many  respects,  like 
that  of  copaiba.  It  has  also  the  general  excitant  properties  of  the 
peppers,  but  it  is  rarely  administered  except  in  disease  of  the 
genito-urinary  mucous  membrane,  on  which  its  action  is  like  that  of 
copaiba,  probably  through  the  operation  of  its  essential  oil,  which 
is  separated  from  it,  passes  into  the  mass  of  the  blood,  and  is  sepa- 
rated along  with  the  urine  by  the  kidney.  Like  copaiba  too,  in  over- 
doses, it  is  apt  to  induce  urticaria,  and  to  excite  inflammation  of  the 
gastro-enteric  mucous  membrane. 

In  gonorrhoea,  it  is  given  under  the  same  circumstances  as  copaiba  ; 
and  like  that  agent,  in  violent  inflammatory  cases,  and  in  the  early 
stages  of  ordinary  cases,  it  may  be  injurious.  There  are  numerous 
instances  on  record,  in  which  unpleasant  circumstances  — as  orchitis, 
and  cystitis — have  resulted  from  its  improper  administration.  Many 
practitioners,  however,  give  it  in  every  stage  of  the  disease. 

In  gleet,  and  chronic  inflammation  in  general  of  the  mucous  mem- 
brane of  the  urinary  organs,  its  employment  is  more  appropriate. 
It  has  been  advised,  also,  in  the  gonorrhoea  of  the  female,  as  well  as 
in  leucorrhoea  ; but  here  its  efficacy  is  more  limited,  aud  some,  in- 
deed, deny  it  to  have  any. 

It  is  affirmed,  that  in  abscess  of  the  prostate,  benefit  has  resulted 
from  the  gentle  stimulus  it  has  afforded  ; and,  in  hemorrhoids,  its 
agency  has  been  likewise  found  beneficial.  In  most  respects,  in- 
deed, its  action  resembles  that  of  copaiba,  (q.  v.)  In  one  respect, 
there  would  appear  to  be  a difference  between  them.  Copaiba  is 
said  to  have  induced  chronic  rheumatism,  whereas,  cubeba  has  been 
administered  in  that  disease,  and,  it  is  said,  advantageously. 

Cubeba  is  commonly  prescribed  in  gonorrhoea  in  powder,  and  in 
doses  of  one,  two,  and  even  four  drachms,  repeated  once  or  oftener 
in  the  day.  In  affections  of  the  bladder  and  prostate,  the  dose  is 
generally  less, — from  ten  to  thirty  grains.  Electuaries,  lozenges, 
and  boluses,  have  likewise  been  prepared  with  it ; but  there  seems 
to  be  no  great  advantage  in  these  formulae. 

In  consequence  of  the  gastric  irritation  sometimes  produced  by 
it,  it  has  been  proposed,  that,  like  copaiba,  it  should  be  given  in 
enema,  to  the  amount  of  one  or  two  drachms  or  more  of  the  powder, 
suspended  in  five  or  six  ounces  of  an  oleaginous  mixture. 

It  is  advisable  to  keep  the  bowels  open  during  its  use,  for  when 
hardened  faeces  are  permitted  to  accumulate,  the  spice,  according  to 
Dr.  Paris,  insinuates  itself  into  the  mass,  and  occasions  excoriations 
of  the  rectum. 

TINCTU'RA  CUBEB'J:  TIIVCTURE  OP  CUBEBS.  (Cubeb.  contus.  |iv  ; AlcoIwL 
dilut.  Oij.  It  may  also  be  made  by  the  process  of  displacement.) 
The  dose  of  this  tincture  is  one  or  two  fluidrachms.  It  is  occasion- 
ally, though  rarely,  used  as  a carminative ; but  it  is  not  unfrequently 
employed  in  gonorrhea. 

The  volatile  oil  — OLEUM  CUBEB  jE  — is  likewise  much  used  by 
VOL.  I. — 40 


470 


SPECIAL  EXCITANTS. 


many  practitioners  in  the  same  disease.  Its  dose  is  10  or  12  drops, 
suspended  in  water  by  means  of  mucilage,  or  dropped  on  sugar. 

On  the  continent  of  Europe,  an  oleo-resinous  extract  of  cubebs,  — 
prepared  by  adding  the  oil  to  the  resinous  extract  of  cubebs,  which 
is  made  by  digesting  the  cake  left  after  the  distillation  of  the  oil  in 
alcohol,  and  distilling  off  the  spirit  — is  occasionally  used  in  gonor- 
rhoea ; as  well  as  an  ethereal  hydro-alcoholic  extract  of  cubebs  ;but  they 
do  not  seem  to  be  preferable  to  the  preparations  already  indicated. 

30.  SINA'PIS.  — MUSTARD. 

Mustard  is  a well-known  acrid  stimulant,  used  as  a condiment  to 
facilitate  the  digestion  of  other  substances,  but  rarely  employed  in- 
ternally as  a therapeutical  agent.  It  is  chiefly  used  in  the  form  of 
cataplasm  as  a revellent ; and  frequently  as  an  excitant  to  the  wrists 
ankles,  or  epigastrium^  where  the  powers  of  the  system  are  much 
prostrated,  as  in  adynamic  fevers,  and  other  diseases  of  a simi- 
lar character,  in  which  it  is  greatly  preferable  to  blisters  ; as  the  latter 
abstract  from  the  system  a quantity  of  serum,  which  can  scarcely 
fail  to  antagonise  the  good  effects,  that  might  follow  from  the  exci- 
tation. Occasionally,  too,  mustard  is  added  to  pediluvia,  to  render 
them  more  excitant.  The  mode  of  formation  and  application  of  the 
cataplasm  is  given  elsewhere.  (See  Revellents.) 

When  it  is  desired  to  exhibit  mustard  internally  as  an  excitant, 
mustard  whey  may  be  given,  which  is  prepared  by  boiling  half  an 
ounce  of  the  bruised  seeds  or  powder  in  a pint  of  milk,  and  strain- 
ing. The  dose  is  f.  §iv.,  two  or  three  times  a day. 

The  volatile  oil — Oleum  Sinapis  — has  been  occasionally  used  as 
a local  excitant ; but  more  frequently  as  a rubefacient  and  vesicant. 

31.  ZIN'GIBER  — GINGER. 

The  rhizoma  of  Zin' giber  officina'lc,  Amo'mum  Zin' giber  ox  narrow- 
leaved Ginger  ; Sex.  Syst.  Monandria  Monogynia  ; Nat.  Ord.  Zin- 
giberaceae  (Lindley),  is  officinal  in  the  various  pharmacopoeias  of 
Great  Britain  and  of  this  country.  Its  native  soil  is  doubtful, — 
supposed  to  be  Asia ; but  it  is  now  cultivated  in  most  tropical  re- 
gions throughout  the  globe.  The  young  shoots  put  forth  in  the 
spring  are  used  in  the  preparation  of  the  well-known  preserve  — 
preserved  Ginger.  At  the  end  of  the  year,  or  beginning  of  the  next, 
when  the  herb  has  withered,  and  before  the  root  becomes  too  woody, 
the  rhizoma  is  in  the  fittest  state  for  yielding  the  ginger  of  the  shops  ; 
which  is  prepared  by  picking  and  cleaning  the  rhizoines,  and  then 
either  scalding  them  in  boiling  water,  and  drying  them  with  artificial 
heat,  or  by  peeling  and  drying  them  in  the  sunshine  without  immer- 
sion in  hot  water.  In  the  former  mode.  Black  Ginger  is  said  to  be 
obtained  ; in  the  latter  White  Ginger.  Dr.  Pereira,  however,  thinks, 
that  this  mode  of  preparation  is  insufficient  to  account  for  the  dif- 
ference between  the  black  and  the  white  ginger,  and  is  disposed 
to  suspect  the  existence  of  some  difference  in  the  plants  themselves. 
When  imported  into  England,  the  common  kinds  are  bleached  by 


ZINGIBER. 


471 


washing  them  in  a solution  of  chlorinated  lime,  and,  sometimes,  by 
exposing  them  to  the  fumes  of  burning  sulphur,  — processes  which, 
as  remarked  by  Dr.  Pereira,  cannot  fail  to  injure  the  aromatic. 

Black  ginger  is  imported  into  this  country  almost  exclusively 
from  Calcutta,  and  is  called  by  the  druggists  East  India  ginger : 
white  ginger  is  imported  from  England,  where  it  is  said  to  undergo 
some  preparation.  It  is  generally  termed  Jamaica  ginger^  and  is 
the  more  prized.  (Wood  & Bache.)  In  England,  the  quantity  of 
ginger  on  which  duty  was  paid,  in  the  year  1840,  was,  according 
to  Dr.  Pereira,  9,063  cwt. ; of  which  7,528  cwt.  were  imported 
from  the  British  West  Indies  ; and  1,535  from  the  East  Indies. 

Black  ginger,  as  found  in  the  shops,  has  a wrinkled  epidermis,  and 
is  of  a dirty  grayish-brown  colour  externally.  The  outer  portion 
is  horny ; the  centre  of  a whitish  colour,  and  somewhat  farinaceous. 
White  ginger  is  destitute  of  the  epidermis  ; of  a pale  grayish-yellow 
colour,  and  of  a more  farinaceous  texture. 

When  subjected  to  analysis,  ginger  has  afforded,  as  main  consti- 
tuents, a volatile  oil,  and  a soft  resin.  Its  starch  has  been  separated, 
of  fine  quality,  and  perfectly  white,  to  the  amount  of  more  than  25 
per  cent.,  by  the  ordinary  process  of  procuring  arrow-root. 

Ginger  is  one  of  the  most  prized  of  the  aromatics,  and  as  such  is 
used  as  a condiment.  It  is  rarely  given  alone,  except  in  domestic 
practice,  when  it  is  often  taken  in  the  form  of  ginger  tea^  in  tormina, 
and  in  gastric  and  intestinal  flatulency.  Therapeutically,  it  is  more 
frequently  used  than  any  other  aromatic,  as  a corrigent  to  sub- 
stances which  are  apt  to  excite  nausea,  gastrodynia  or  tormina.  It 
is  occasionally  used  as  a collutory  and  gargle  in  relaxation  of  the 
uvula,  and  in  relaxed  sore  throat ; and,  at  times,  is  applied  as  an 
excitant  and  rubefacient  to  the  skin ; but  it  is  inferior  to  mustard, 
and  is,  therefore,  rarely  applied. 

The  dose  of  the  powder,  as  an  excitant,  is  from  gr.  x to  gr.  xx, 
or  more.  The  infusion  — ginger  tea — maybe  made  of  from  ^ij 
to  5iv  of  ginger  to  Oss  of  boiling  water  ; sweetened,  and  taken  in 
doses  of  one  or  two  table-spoonfuls. 

TINCTU'RA  ZmClB'ERIS,  TINCTURE  OF  GINGER.  {Zingib.  contus.  gviij ; Al- 
cohol. Oij,  — prepared  by  maceration  or  by  displacement.)  Tincture 
of  ginger  is  an  excellent  carminative.  It  is  rarely,  however,  given 
alone  ; but  is  an  excellent  adjunct  to  tonic  and  cathartic  mixtures. 
It  is  chiefly  used  in  the  preparation  of  the 

SYR'UPUS  ZINGIB'ERIS,  SYRUP  OF  GINGER.  {Tinct.  Zingib.  f.  §iv; 
Syrup,  cong.)  A syrup  may  also  be  made  extemporaneously  by  mix- 
ing tincture  of  ginger  with  simple  syrup.  It  is  added  to  tonic  and 
cathartic  mixtures  to  prevent  flatulence,  and  give  flavour.  It  is 
much  used,  likewise,  as  an  addition  to  the  common  soda  water  as 
drunk  at  the  fountain. 

Ginger  enters  into  the  composition  of  the  Acidum  Sulphuricum 
aromaticum.,  the  Pulvis  aromaticus^  the  Tinctura  Cinnamomi  com- 
posita,  and  the  Vinum  Aloes  of  the  Pharmacopoeia  of  the  United  States. 


472 


SPECIAL  EXCITANTS. 


32.  ARMORA'CIA.— HORSE-RADISH. 

Horseradish  whose  general  properties  have  been  described  else- 
where (p.  263)  — is  a well  known  excitant  condiment,  when  fresh  ; 
and  is  adapted  therefore  to  act  as  an  internal,  as  well  as  an  external 
excitant : it  is  likewise,  to  a certain  extent,  diuretic  ; but  it  is  rarely 
employed  in  medicine  ; and  Dr.  Christison  has  remarked  that  ‘‘  on 
the  whole,  it  might  be  expunged  from  the  pharmacopoeias  with  little 
inconvenience.” 

The  dose,  as  an  excitant,  when  scraped  into  shreds,  is  ^ss  or 
more. 

The  Pharmacopoeia  of  the  United  States  has  an 

INFU'SUM  ARMORA'CIJ],  INFU  SION  OF  HORSE'RADISH.  (Jirmomc.  inci&., 
SinapiSj  contus.  aa  §j  ; hullient.  Oj.)  The  infusion  is  rarely  pre- 
scribed. It  has  been  advised  in  chronic  rheumatism,  paralysis,  and 
in  dropsies  of  an  asthenic  kind.  The  dose  is  f.  §ss  to  f.  §ij,  two 
or  three  times  a day. 

33.  TEREBIN'THINA.  — TUR-PENTINE. 

The  term  turpentine  is  usually  given  to  vegetable  juices,  liquid 
or  concrete,  which  consist  of  resin,  and  a peculiar  volatile  oil,  sepa- 
rable by  distillation,  called  Oil  of  Turpentine. 

The  only  turpentines,  that  are  officinal  in  the  Pharmacopoeia  of 
the  United  States,  are  TEREBIN'THINA,  TURTENTINE,  the  juice  of  Pinus 
Palustris,  Long-leaved  Pine,  Yellow  Pine,  Pitch  Pine,  Swamp  Piney 
and  other  species  of  Pinus.  Sex.  Syst.  Monoecia  Monadelphia  ; 
Nat.  Ord.  Coniferse  ; and  TEREBIN'THINA,  CAMDEN'SIS ; Can'ada  Tur- 
pentine, Canada  Balsam,  or  Balsam  of  Fir,  the  juice  of  A'hies  Bal- 
same'a,  Cana'dian  Balsam  Fir,  Balm  of  Gilead  Fir,  Amer'ican  Silver 
Fir. 

1.  TEREBIN'THINA,  of  the  Pharmacopoeia  of  the  United  States,  American, 
or  White  Turpentine  — the  juice  of  Pinus  chiefly,  is  not 

identical  with  the  common  European  turpentine,  which  is  the  pro- 
duce of  Pinus  Sylves'tris,  Wild  Pine,  or  Scotch  Fir.  It  is  chiefly 
obtained  from  Virginia  and  North  Carolina,  and  is  procured  as  follows. 
In  the  winter  months,  holes  are  made  in  the  trunk  of  the  tree,  three 
or  four  inches  from  the  ground,  wffiich  are  capable  of  holding  two  or 
three  pints,  or  more,  into  which,  in  the  spring,  the  juice  begins  to 
flow,  and  continues  through  the  summer  and  autumn.  The  juice  is 
removed  from  these  holes  as  they  fill,  and  is  transferred  into  casks, 
in  which  it  acquires  the  consistence  of  a soft  solid.  The  quantity  of 
raw  turpentine  used  by  the  turpentine  distillers  of  Wilmington,  N.  C., 
alone,  is  astonishing  It  is  stated  in  the  North  Carolina  Chronicle, 
published  in  that  town,  that  there  are  three  establishments,  which 
work  up  about  200  barrels  a day,  making  betw’een  62,000  and 
63,000  barrels  per  annum.  75,000  or  80,000  barrels,  it  was  ex- 
pected, would  be  used  in  the  year  1843.  Besides,  nearly  100,000 
barrels  were  shipped  from  Wilmington  in  the  year  ending  the  first  of 
July,  1842. 


TEREBINTHINA. 


473 


Turpentine,  procured  as  above,  has  the  odour  that  is  charac- 
teristic of  all  the  terebinthinates  ; a warm,  pungent,  bitterish  taste, 
and  a white  colour  tinged  with  yellow.  Its  consistence  varies  with 
the  temperature. 

8.  TEREBIN'TIIINA  CANADEN'SIS;  oxCan'ada  Tur'pentine  — the  juice  of 
Jl’hies  Balsame'a  — is  collected  in  Canada  and  the  State  of  Maine. 
Between  the  bark  and  the  wood  of  the  trunks  and  branches  are  vesi- 
cles, which  contain  the  turpentine.  This  exudes  when  they  are 
broken,  and  is  received  into  a bottle.  When  fresh,  it  is  of  the  con- 
sistence of  thin  honey,  but,  by  time  and  exposure,  it  becomes  more 
and  more  solid.  It  is  yellow,  transparent,  very  tenacious,  possessing 
the  terebinthinate  odour  in  an  agreeable  form,  and  having  the  taste 
of  those  substances.  In  this  country,  it  is  usually  brought  to  market 
in  bottles,  but  it  is  exported  to  England  in  casks.  In  1838,  the 
quantity  imported  into  England  was,  according  to  Dr.  Pereira,  7259 
pounds. 

Both  these  turpentines  yield  17  or  18  per  cent,  of  volatile  oil  on 
distillation. 

Besides  these  turpentines,  which  are  officinal  in  this  country,  there 
are  others  — as  1.  the  Common  Europe' an  Tur’pentine — Tere- 
binth'ina  Vulga^ris — which,  as  already  remarked,  is  procured  from 
Pinus  Sylves'tris ; 2.  the  Larch,  or  Venice  Turpentine  — Terebinth'- 
iNA  Ven'eta  — obtained  from  Larix  EuropcB'a,  or  Common  Larch; 

3.  The  Chian,  or  Cyprus  Turpentine  — Terebinth'ina  Chia  seu 
Cyp'ria  — obtained  from  Pista'cia  Terebinth' us,  or  Tur'pentine  Pis- 
ta'chia  ; Sex.  Syst.  Dioecia  Pentandria  ; Nat.  Ord.  Terebinthacese  ; 

4.  The  Bourdeaux'  Tur'pentine,  from  Pinus  Pinas'ter,  or  P.  Marit'- 

ima,  the  Pinas'ter  or  Cluster  Pine;  5.  the  Strasburg  Tur'pentine, 
Terebinth'ina  Argentoraten'sis,  from  A'hies  Pice' a,  or  Silver  Fir 
of  Europe  ; 6.  Common  Frankincense — Abie'tis  Resi'na,  Thus, 

from  A'bies  Commu'nis ; 7.  the  Damar'ra  Tur'pentine,  from  Pinus 
Damar'ra,  which  grows  in  the  East  India  Islands  ; and  8.  the  Dom- 
bey'a  Turpentine,  the  produce  of  Dombey'a  Excel' sa,  a native  of 
Chili. 

All  the  terebinthinate  oleo-resins  resemble  each  other  in  smell  and 
taste.  They  soften  and  become  liquid  by  heat,  readily  take  fire,  and 
burn  with  a white  flame,  giving  off  much  smoke,  which,  in  a confined 
space,  occasions  a copious  deposition  of  lampblack.  They  yield,  by 
distillation,  a large  quantity  of  volatile  oil,  leaving  a residuum  con- 
sisting of  resin.  They  are  readily  soluble  in  alcohol  and  ether,  and 
unite  with  the  fixed  oils.  Water  extracts  only  a small  portion  of  the 
volatile  oil,  but  becomes  largely  impregnated  with  its  flavour. 

All  the  terebinthinate  preparations  owe  their  medical  properties  to 
their  volatile  oil,  which,  like  other  volatile  oils,  is  excitant,  — occa- 
sioning, when  swallowed,  a sense  of  heat  in  the  stomach,  and,  in 
large  doses,  nausea,  and  augmentation  of  the  peristaltic  action  of  the 
bowels.  The  essential  oil  is  absorbed  into  the  blood-vessels,  operate 
40* 


474 


SPECIAL  EXCITANTS. 


ing  on  the  system  as  an  excitant,  and  passing  to  the  kidneys  — 
partly  changed  and  partly  unchanged  — where  it  is  separated  along 
with  the  urine — in  small  quantities  increasing  the  secretion  from  those 
organs,  and  in  larger,  giving  rise,  at  times,  to  nephritic  symptoms, 
to  hsematuria,  and  to  strangury.  It  is  also  exhaled  from  other  secern- 
ing surfaces,  as  the  skin  and  mucous  membranes  generally.  Hence 
it  is,  that  the  turpentines  have  been  administered  in  affections  of  the 
mucous  membranes  in  general,  and  of  the  urinary  organs  in  par- 
ticular. 

None  of  the  turpentines  are,  however,  much  used,  in  consequence 
of  their  virtues  being  wholly  possessed  by  the  volatile  oil,  under 
which  the  diseases  will  be  mentioned  in  which  they  are  prescribed. 

The  dose  of  the  turpentines  is  from  a scruple  to  a drachm.  They 
may  be  made  into  pills  with  powdered  liquorice  ; into  an  emulsion 
with  mucilage  of  gum  arabic  or  yolk  of  egg,  sugar,  and  mint  water  ; 
or  into  an  electuary  with  honey  or  molasses. 

If  the  Bourdeaux  turpentine  be  mixed  with  about  one-twenty-eighth 
part  of  its  weight  of  calcined  magnesia,  it  solidifies  in  about  twelve 
hours, — the  acid  resins  combining  with  the  magnesia,  and  forming 
solid  resinates,  which  absorb  the  volatile  oil. 

An  emulsion  of  the  turpentines  may  also  be  thrown  into  the  rec- 
tum as  an  excitant  injection,  when  it  is  advisable  to  induce  catharsis 
and  revulsion  at  the  same  time,  as  in  comatose  affections. 

The  turpentines  enter  into  the  composition  of  certain  plasters. 

«.  O'LEUM  TEREBIN  THINJl,  OIL  OF  TURTENTIIVE.  This  oil  is  prepared 
on  the  large  scale,  and  is,  consequently,  not  in  the  list  of  prepara- 
tions, but  in  that  of  the  materia  medica  of  the  Pharmacopeeia  of  the 
United  States,  as  well  as  of  those  of  Europe.  All  the  turpentines 
yield  it,  but  in  this  country  it  is  prepared  chiefly  from  Finns  Palus'- 
tris^  which  affords  about  17  per  cent.,  and  from  which  it  is  distilled 
in  large  quantities  in  North  Carolina,  not  only  for  home  consumption, 
but  for  exportation.  The  residue  in  the  still,  after  the  distillation  of 
the  oil,  is  resin. 

In  the  British  colleges,  oil  of  turpentine  is  directed  to  be  re- 
distilled^; but  in  this  country,  it  can  always  be  had  sufficiently  pure  for 
medical  use  ; so  that  the  apothecary  rarely  has  recourse  to  a hazard- 
ous process  ; and,  accordingly,  no  formula  for  its  rectification  is  given 
in  the  Pharmacopoeia  of  the  United  States. 

Pure  oil  of  turpentine  is  limpid  and  colourless,  having  a peculiar 
penetrating  odour,  and  a hot,  pungent,  bitterish  taste.  Its  specific 
gravity  is  about  0.86.  It  is  highly  volatile  and  inflammable  ; less 
soluble  in  alcohol  than  most  other  volatile  oils,  and  very  slightly  so 
m water,  and  in  dilute  or  hydrated  alcohol.  It  is  readily  soluble  in 
sulphuric  ether. 

Oil  of  turpentine  is  a powerful  excitant,  diuretic,  anthelmintic 
and  in  large  doses  cathartic  ; but  its  excitant  properties  alone  fall 
under  consideration  here.  In  small  doses  — from  a few  drops  to  a 
drachm  - — it  causes  a feeling  of  warmth  in  the  stomach  ; is  absorbed. 


OLEUM  TEREBINTHINJE. 


475 


and  passes  off  by  the  kidneys,  and  the  different  emunctories ; so  that 
the  cutaneous  and  pulmonary  transpirations  have  a marked  terebin- 
thinate  — and  the  urine  a violet  — odour,  the  latter  supposed  to  be 
owing  to  a portion  of  the  oil  being  decomposed. 

Owing  to  its  excitant  operation,  it  proves  beneficial  in  chronic  in- 
flammations of  mucous  membranes  accompanied  by  discharges  ; and, 
not  unfrequently,  even  in  small  doses,  causes  haematuria,  and  great 
irritation  of  the  urinary  organs.  These  effects  are  still  more  marked, 
w’hen  the  dose  is  larger — from  f.  3j,  for  example,  to  f.  5ij*  In  still 
larger  doses,  from  f.  3ij  to  f.  §iss,  and  even  more,  it  induces  much 
concentration  of  action  towards  the  abdominal  viscera  ; purging  at 
times,  and  passing  off  freely  by  all  the  excretions,  so  as  to  impreg- 
nate the  air  of  the  chamber ; — in  some  cases,  disordering  the  en- 
cephalic functions,  but  not  causing  any  permanent  ill  effects.  It  has 
been  given  to  the  extent  of  three  ounces  without  injury. 

Oil  of  turpentine  is  used  as  an  internal  excitant  in  protracted  fevers 
accompanied  by  typhoid  symptoms,  especially  if,  at  the  same  time, 
there  be  meteorism  or  ulceration  of  the  intestines.  On  most  respect- 
able authority,  that  of  Dr.  Wood,  of  Philadelphia,  it  is  affirmed  that 
there  is  a particular  state  of  fever,  usually  attended  with  much  dan- 
ger, in  which  the  remedy  has  been  found  uniformly  successful : — 
this  is  in  the  latter  stages  of  typhoid  fevers,  or  lingering  remittents, 
‘‘  in  which  the  tongue,  having  begun  to  throw  off  its  load  of  fur  in 
patches,  has  suddenly  ceased  to  clean  itself,  and  become  dry  and 
brownish.  The  skin  is  at  the  same  time  dry,  the  bowels  torpid  and 
distended  with  flatus,  and  the  patient  sometimes  affected  with  slight 
delirium.  Under  the  use  of  small  doses  of  turpentine,  frequently 
repeated,  the  tongue  becomes  moist  and  again  coated,  the  tympanitic 
state  of  the  bowels  disappears,  and  the  patient  goes  on  to  recover  as 
in  a favourable  case  of  fever.”  Dr.  Wood  is  disposed  to  ascribe  the 
effect  to  a healthy  change  produced  by  the  oil  on  the  ulcerated  sur- 
face of  the  intestines;  but  the  author  has  seen  its  excitant  influence 
exhibited  in  similar  cases,  when  there  was  no  reason  to  believe  in 
the  presence  of  intestinal  ulceration. 

In  similar  conditions  in  yellow,  puerperal,  and  eruptive  fevers,  the 
internal  use  of  the  oil  has  been  found  beneficial. 

Like  copaiba,  oil  of  turpentine  has  been  found  serviceable  in  cases 
of  chronic  dysentery  and  diarrhoea ; in  chronic  blenorrhoea  and  leu- 
corrhoea  — less  so,  however,  in  the  last  affection,  as  has  been  shown 
to  be  the  case  with  copaiba  (q.  v.),  and  in  chronic  inflammation  of 
the  bladder ; but  in  the  last  disease  its  administration  requires  cau- 
tion, as  it  is  apt  — especially  if  the  quantity  be  too  great  — to  excite 
increased  irritation. 

In  chronic  rheumatism,  it  has  been  more  largely  employed  than 
any  other  remedy  ; and  in  sciatica,  and  other  neuralgic  aflections, 
the  benefit  obtained  from  it  is  often  marked.  It  acts  probably,  in 
such  cases,  as  a revellent,  by  its  excitant  effect  upon  the  kidneys 
and  urinary  apparatus  in  general. 

It  is  occasionally,  but  rarely,  given  as  a carminative ; the  ordinary 


476 


SPECIAL  EXCITANTS. 


essential  oils  appearing  to  be  productive  of  as  much  service,  whilst 
they  are  agreeable,  and  consequently  are  preferred. 

It  can  be  readily  seen,  that  its  excitant  action,  like  that  of  other 
essential  oils,  and  local  stimulants,  may  be  invoked  in  many  cases, 
where  it  is  desirable  to  induce  a revellent  action,  with  the  view  of 
breaking  in  upon  any  diseased  condition. 

Externally,  oil  of  turpentine  is  employed  extensively  as  a rubefa- 
cient. In  protracted  and  typhoid  fevers,  it  is  applied  hot  or  cold  to 
the  extremities;  and  in  chronic  rheumatism,  paralysis,  cynanche, 
puerperal  peritonitis,  and,  whenever  it  is  desirable  to  excite  cuta- 
neous revulsion,  it  is  constantly  prescribed,  either  alone  or  associated 
with  olive  oil,  which  renders  its  action  milder. 

In  those  cases  of  extensive  burns  and  scalds,  that  are  accompanied 
by  much  constitutional  depression,  oil  of  turpentine  has  been  found 
a most  valuable  local  excitant ; as  well  as  in  gangrenous  conditions 
in  general,  where  the  object  is  to  restore  the  part  from  a state  of  sus- 
pended animation. 

Oil  of  turpentine  is  the  principal  ingredient  in  Whitehead^s  essence 
of  mustard^  w^hich  consists  of  it,  camphor,  and  a portion  of  spirit  of 
rosemary,  to  which  is  added  a small  quantity  of  flour  of  mustard. 
This  is  a celebrated  rubefacient  application  in  chronic  rheumatism, 
neuralgia,  &c.  St.  John  Long^s  liniment,  which  acquired  so  much 
notoriety  about  twenty  years  ago,  is  said  to  have  consisted  of  oil  of 
turpentine  and  acetic  acid,  held  in  suspension  by  yolk  of  egg. 

United  with  olive  oil,  {01.  terehinthin.  Jj  ; 01.  olivce,  ^vij  ;)  and 
introduced  into  the  meatus  auditorius  externus  on  cotton,  it  occa- 
sionally acts  beneficially  as  an  excitant,  where  there  has  been  a de- 
ficient secretion  of  cerumen. 

Oil  of  turpentine  is  likewise  administered  in  many  cases,  with 
marked  advantage,  in  the  form  of  enema.  In  amenorrhoea,  its  ex- 
citant influence  has,  in  this  w^ay,  been  beneficial  by  contiguous  sym- 
pathy. In  fevers,  accompanied  by  meteorism,  it  is  often  highly  ser- 
viceable ; and  in  comatose  affections,  w'here  it  is  desirable  to  induce 
a revellent  action  on  the  lower  part  of  the  intestinal  canal.  Its  em- 
ployment in  thisform  has,  however,  fallen  under  consideration  already, 
when  treating  of  Cathartics. 

The  ordinary  dose  of  oleum  terebinthinse,  as  an  excitant  in  fever, 
or  chronic  catarrh  of  the  mucous  membranes,  and  in  chronic  rheu- 
matism, is  from  rt^v  to  f.  3j  ; but  even  in  the  smallest  doses,  it  gives 
occasion,  at  times,  to  bloody  urine,  and  to  nephritic  and  vesical  irri- 
tation. Some,  however,  administer  it  in  those  diseases  to  the  extent 
of  f.  5j  to  f.  ;^ij. 

It  may  be  taken  in  molasses,  or  dropped  on  some  aromatic  water, 
to  w’hich  a hot  aromatic  or  bitter  tincture  has  been  added — as  the 
tincture  of  capsicum  or  tincture  of  gentian  — to  conceal  its  taste.  It 
is  more  commonly,  however,  given  in  emulsion,  as  in  the  following 
prescription  : [01.  terehinthin.  f.  — ^iij  ; Vitell.  ovi,  sen  Mucilag. 
iicacice,  f.  jiij  ; Aquce  menthce piperitce,  f.  jiv.  M.  Dose,  a fourth  part.) 

When  given  in  enema,  the  quantity  of  the  oil  may  be  increased. 


RESINA. 


4m 

and  water  may  be  substituted  for  the  aqua  menthse  piperitse.  A form 
for  an  enema  of  this  kind  — Enema  Terebinthina:  — is  officinal  in 
the  Pharmacopoeias  of  London,  Edinburgh,  and  Dublin. 

IINOIEN'TUM  TEREBIN'TfflNJ,  LINIMENT  OF  TUR'PENTINE.  {01  terehin-^ 
thin.  Oss  ; Cerat.  resin,  tbj.)  This  was  the  liniment  originally  pro- 
posed by  Kentish  for  the  treatment  of  burns  and  scalds.  It  is  spread 
upon  lint,  and  kept  on  until  the  peculiar  inflammation  excited  by  the 
fire  has  been  removed.  It  may  then  be  continued,  or  milder  dress- 
ings be  substituted,  as  the  case  may  seem  to  demand.  It  may,  also, 
be  applied  in  cases  of  gangrenous  or  sloughing  ulcers,  or  wherever 
a topical  application  of  the  kind  is  needed. 

h.  RESI  NA,  RESIN  or  ROSIN.  This  is  the  residuum  after  the  distilla- 
tion of  the  volatile  oil  from  the  turpentine  of  Pinus  palustris,  and 
other  species  of  pinus.  When  the  distillation  is  not  carried  too  far, 
the  resin  contains  a little  water.  This  is  the  officinal  article  — Re- 
sina — of  the  Pharmacopoeia  of  the  United  States  — the  Resina  Jlava 
or  yellow  resin  or  rosin.  If,  in  a state  of  fusion,  it  be  strongly  agi- 
tated with  water,  it  acquires  a distinct  appearance,  and  is  called 
Resina  alha  or  white  rosin.  This,  according  to  Christison,  is  the 
resin  of  pharmacy  ; but  it  is  not  so  in  this  country.  A more  con- 
tinued heat  than  that  prepared  in  making  the  yellow  rosin,  expels 
the  water,  and  produces  transparent  rosin  ; and  if  the  process  be 
pushed  as  far  as  it  can  be,  without  producing  a complete  alteration 
of  properties,  the  residue  acquires  a deeper  colour,  and  is  termed 
brown  or  black  rosin,  colophony,  and  JiddlePs  rosin.  If  melted  rosin 
be  run  into  cold  water,  contained  in  shallow  tanks,  and  a supply  of 
cold  water  be  kept  up  until  the  rosin  has  solidified,  a pale  yellow 
product  is  obtained  called  Flockton's  patent  rosin.  (Pereira.) 

Resin  and  the  resins  in  general  are  insoluble  in  water,  but  are 
dissolved  by  alcohol,  ether,  and  the  essential  oils,  — the  solutions  in 
alcohol  and  ether  affording  precipitates  on  the  addition  of  water. 
They  unite  with  wax  and  the  fixed  oils  by  fusion,  and  form  soaps 
with  the  caustic  alkalies. 

Yellow  resin,  as  usually  met  with,  is  opaque,  and  of  a yellow  or 
yellowish  white  colour.  White  resin  differs  from  the  yellow  in  being 
opaque  and  whitish,  — properties  which  are  owing  to  the  water  with 
which  it  is  incorporated,  and  which  gradually  escapes  on  exposure, 
leaving  it  more  or  less  transparent. 

Resin  is  never  given  internally.  Its  main  use  is  to  form  plasters 
and  ointments,  to  which  it  is  an  excitant  ingredient,  and  renders 
them  more  adhesive. 

CERATUM  RESI'NJ,  RESIN  CERATE,  BasiVicon  ointment.  {Resin,  |v ; 
Mipis.  iviij  ; Cerce flavw,  ^ij.)  A mild  excitant  ointment,  to  in- 
dolent ulcers  ; to  blistered  surfaces  to  keep  up  a discharge,  and 
to  ulcers  which  follow  burns. 

CERl'TUM  RESI  NJ  COMPOS'ITUM,  COMPOUND  RESIN  CERATE.  {Resin.,  Sevi, 
Cerce  jiavcc,^^  tbj  ; Terebinth,  tbss  ; 01.  Uni,  Oss.)  This  ointment 


478 


SPECIAL  EXCITANTS. 


is  somewhat  more  excitant  than  the  preceding.  It  is  employed  in 
some  parts  of  the  United  States,  under  the  name  of  Deshler^s  salve, 

34.  COPA'IBA.  — COPA'IBA. 

The  juice  of  Copaifera  officina’lis^  and  other  species  of  copaifera, 
Sex.  Syst.  Decandria  Monogynia ; Nat.  Ord.  Legurninosse,  natives 
of  South  America,  is  commonly  known  under  the  name  Balsam  of 
Copa'iva,  or  Copa’iva  Balsam.  It  is  obtained  by  making  incisions 
into  the  stems  of  the  trees,  from  which  it  flows  copiously ; and  the 
incisions  are  repeated  several  times  in  the  course  of  the  season.  It 
would  seem  to  be  collected  in  greatest  quantity  in  the  province 
of  Para,  in  Brazil,  and  is  imported  into  the  United  States  almost 
'wholly  from  the  port  of  Para,  in  small  casks  or  barrels.  (Wood  & 
Bache.)  A considerable  quantity,  according  to  Dr.  Pereira,  is  im- 
ported into  England  through  New  York. 

Copaiba  is  a yellowish  transparent  liquid,  of  the  consistence 
of  syrup  or  olive  oil,  and  of  a specific  gravity  varying  from 
0.950  to  1000  ; rarely,  perhaps,  as  high  as  the  latter,  unless  after 
long  keeping.  Its  odour  is  peculiar,  and  taste  somewhat  pungent, 
bitterish  and  nauseous.  It  is  not  soluble  in  water,  but  is  wholly 
so  in  alcohol,  ether,  and  the  fixed  and  volatile  oils.  With  the 
alkalies  it  forms  a soap,  which  is  insoluble  in  water. 

The  tests  of  its  purity,  as  laid  down  by  the  Edinburgh  College, 
the  following : ‘‘  transparent ; free  of  turpentine  odour  when 

heated  ; soluble  in  two  parts  of  alcohol  ; it  dissolves  a fourth  of 
its  weight  of  carbonate  of  magnesia,  with  the  aid  of  a gentle  heat, 
and  continues  translucent.”  It  is  not,  however,  often  adulterated 
in  this  country. 

The  chief  constituents  of  copaiba  are  volatile  oil  and  resin.  It 
contains  no  benzoic  acid,  and  is,  therefore,  not  properly  a balsam, 
under  the  modern  definition  of  the  word.  It  more  nearly  resem- 
bles, in  its  chemical  and  medicinal  properties,  the  turpentines.  By 
distillation,  a volatile  oil — Oleum  Copaibad  — is  obtained  from  it, 
which  is  officinal  in  the  Edinburgh  Pharmacopoeia,  and  is  pre- 
ferred by  some,  as  a medicinal  agent,  to  any  other  form  of  preparation. 

The  quantity  of  volatile  oil  varies  according  to  the  specimen  of 
copaiba,  but  the  average  produce  has  been  estimated  at  from  40 
to  45  per  cent.  (Pereira).  After  the  oil  has  passed  over,  a resin  of 
copaiba  remains,  which  consists  of  two  resins  — one  called  Copa'- 
ivic  acid,  and  the  other  Viscid  resin  of  Copa'iva ; but  these  last 
constituents  are  of  no  pharmacological  interest.  The  following 
analyses  are  cited  by  Pereira  : 


STOLZE’S  ANALYSIS.  GERBER’S  ANALYSIS; 

Fresh  Balsam.  Old  Balsam. 

Volatile  oil. 

38.00 

41.00 

31.70 

Yellow  hard  resin  [Copaivic  acid,) 

52.75 

51.38 

53.68 

Brown  soft  resin. 

1.66 

2.18 

11.16 

Water  and  loss. 

7.59 

5.44 

4.10 

Balsam  of  Copaiba, 

100.00 

100.00 

100.63 

COPAIBA. 


479 


It  is  not  many  years  since  it  was  discovered,  that  if  magnesia 
be  triturated  with  copaiba,  and  the  mixture  be  set  aside,  it  will 
gr^ually  assume  such  a consistence  as  to  admit  of  being  made  into 
pills  ; a formula  for  which  is  officinal  in  the  Pharmacopoeia  of  the 
United  States. 

The  effect  of  copaiba  on  the  human  frame,  like  that  of  the  oleo- 
resins  — as  the  turpentines  — is  unquestionably  excitant.  It  occa- 
sions, when  swallowed,  a sense  of  heat  in  the  pharynx,  oesophagus 
and  stomach,  giving  rise  to  eructations  of  the  characteristic  flavour  of 
copaiba,  and  in  over  doses,  to  nausea  and  vomiting.  With  some  per- 
sons, indeed,  the  smallest  quantity  produces  those  effects,  which  is  a 
strong  objection  to  its  administration  in  an  uncombined  form. 

It  is  also  apt  to  induce  a form  of  urticaria  through  sympathy  with 
the  gastro-enteric  irritation  which  it  occasions.  This  passes  away 
however,  when  the  copaiba  is  discontinued. 

The  action  of  copaiba  is  not  confined  to  the  gastro-enteric  mucous 
surfaces.  It  is  presumed,  by  many,  to  affect,  more  or  less,  all  the  mu- 
cous surfaces,  and,  accordingly,  is  extensively  employed  in  chronic 
inflammations  of  those  expansions.  The  oil  is  likewise  taken  up  into 
the  blood-vessels  of  the  stomach  and  intestines,  and  proceeds  to  the 
kidneys,  where  it  is  separated  along  with  the  urine  ; and  excites,  at 
times,  nephritis,  hsematuria,  and  ischuria,  with  occasional  irritation  of 
the  urethral  mucous  membrane.  It  is,  likewise,  exhaled  along  with 
the  pulmonary  transpiration,  as  its  odour  is  distinctly  perceptible  in  the 
breath.  Where  unusual  doses  of  copaiba  are  taken,  all  those  symp- 
toms are  greatly  aggravated.  It  is  affirmed,  too,  that  under  its  use 
pains  of  a rheumatic  character  have  supervened,  which  there  was 
great  reason  to  ascribe  to  its  agency. 

The  principal  therapeutical  employment  of  copaiba  is  unquestion- 
ably in  inflammatory  affections  of  the  genito-urinary  organs,  and 
especially  in  gonorrhoea.  In  the  last  disease,  it  probably  acts  mainly 
as  a revellent  by  the  impression  which  it  makes  on  the  mucous  mem- 
brane of  the  stomach  and  intestines,  and  likewise,  on  the  kidney ; 
and  it  is  not  improbable,  in  the  more  chronic  form  of  mucous  dis- 
charge, that  the  excitant  virtue  of  the  oil,  which  becomes  separated 
with  the  urine,  may  exert  a beneficial  agency  on  the  diseased  sur- 
face with  which  it  comes  in  contact.  With  most  modern  writers, 
indeed,  copaiba  is  one  of  the  main  agents  in  the  revellent  treatment 
of  gonorrhoea.  The  author  has  elsewhere  stated  {Practice  of  Medi- 
cine^ 2d  edit,  ii.,  381,  Phila.  1844,  that  after  the  active  symptoms  of 
gonorrhoea  have  passed  away  under  a simple  antiphlogistic  manage- 
ment, the  revellent  treatment  becomes  advisable,  which  consists  in 
the  administration  of  substances,  that,  either  by  their  operation  on 
the  kidneys,  or  on  the  diseased  mucous  membrane  itself,  induce  a 
new  action  in  it.  Many  practitioners  as  are  in  the  habit,  however, 
of  administering  copaiba  freely  from  the  very  first,  payingmo  regard 
whatever  to  any  antiphlogistic  treatment;  but  although  this  plan 
may  prove  successful  occasionally,  it  has  been  found  at  times  to 
augment  the  inflammatory  symptoms,  and  the  discharge.  Its  efficacy. 


480 


SPECIAL  EXCITANTS. 


is,  doubtless,  more  appropriate,  and  its  employment  more  philso- 
phicaljwhen  prescribed  after  an  appropriate  antiphlogistic  treatment. 

In  the  gonorrhoea  of  females,  copaiba  and  the  different  revellent 
antigonorrhoeal  remedies  appear  to  be  of  limited  efficacy.  Gonor- 
rhoea in  the  female,  in  reality,  affects  the  vagina  rather  than  the 
urethra,  and  we  can,  therefore,  comprehend,  that  the  effect  of  its 
revulsive  agency  on  the  kidney  may  be  less  marked  than  when  .the 
disease  is  confined  to  the  lining  membrane  of  the  urethra,  as  in 
the  male. 

In  chronic  inflammation  of  the  bladder,  copaiba  has  been  pre- 
scribed, but  its  effects  have  to  be  watched,  or  it  may  add  materi- 
ally to  the  inflammation. 

^ As  in  gonorrhoea  of  the  female,  so  in  leucorrhoea  it  cannot  be  ex- 
pected, that  copaiba  could  afford  essential  benefit.  Cases,  indeed, 
are  recorded  of  advantage  from  it,  but  it  is  not  much  relied  on. 
The  same  may  be  said  of  its  use  in  chronic  bronchitis,  in  which  it 
has  been  extolled  by  many  practitioners.  Its  agency,  in  such  cases, 
also,  is  probably  revellent  by  exciting  the  lining  membrane  of  the 
stomach. 

It  can  scarcely  be  expected,  that  the  small  quantity,  exhaled  along 
with  the  bronchial  or  pulmonary  transpiration,  can  exert  much  agency. 
This  is  a topic,  however,  which  is  investigated  under  the  head  of 
Expectorants. 

In  cases  of  chronic  inflammation  of  the  mucous  membrane"  of 
the  bowels,  more  effect  may  be  expected  from  it,  inasmuch  as  it 
can  come  into  immediate  contact  with  the  seat  of  the  disease.  It 
is  true,  that  where  this  is  low  down  in  the  bowels,  the  copaiba  will 
be  probably  despoiled  of  the  greater  portion  of  its  oil,  before  it 
reaches  it  ; but  still  sufficient  may  remain,  and  the  resin  of  copaiba 
will  certainly  pass  through  the  bowels.  Strong  testimony  has  been 
adduced  by  a respectable  physician,  Dr.  La  Roche,  of  Philadelphia,  in 
favour  of  its  beneficial  influence  in  cases  of  chronic  inflammation  of 
the  colon  and  rectum,  and  it  is  said  to  have  been  useful  in  hemor- 
rhoids, both  when  employed  in  small  doses  internally,  and  when 
applied  to  them  externally,  after  the  activity  of  the  inflammatory 
stage  had  passed  away. 

Like  the  balsams,  it  has  occasionally  been  used  as  an  excitant  to 
ulcers,  but  at  the  present  day  is  rarely,  if  ever,  employed.  It  has 
also  been  found  serviceable  as  a topical  application  in  chilblains, 
by  Dr.  Ruschenberger,  U.  S.  N.  These  are  the  chief  cases  in  which 
its  excitant  agency  has  been  employed. 

The  ordinary  dose  of  ccpaiba  is  from  n\^x  to  f.  5j,  and  even  more, 
two  or  three  times  a day.  It  is  commonly  given  dropped  on  sugar  ; 
but  its  taste  is  so  repulsive,  that  it  is  often  advisable  to  adopt  other 
forms  with  the  view  of  concealing  it,  and  at  the  same  time  of  cor- 
recting its  effects  upon  the  digestive  organs.  The  following  is  an 
unpharmaceutical  compound,  which  has  often  been  })rescribed  in 
gonorrhoea  ; the  spirits  of  nitre  and  lavender  being  added  to  correct 
the  taste,  and  the  opium,  to  prevent  nausea  or  catharsis.  (Copaiba., 


COPAIBA. 


481 


Sp.  JEthcr.  nitric,  aa  f.  ^.ss  ; Acadccpulv..^  Sacchari.,  ; Sp.  Lavan^ 
dul.  comp.  f.  ; Tinct.  opii.^  f.  5]  ; Aqux  destillat.  f.  ^iv.  — M.  The 
dose  of  this  is  a table-spoonful  three  times  a day.)  Many  of  the  more 
recent  writers,  however,  prefer  to  give  it  alone,  in  wine  or  lemon- 
ade, or  dropped  in  a wine-glassful  of  water,  to  which  a little  com- 
pound tincture  of  gentian  has  been  added. 

Where  copaiba  is  given  from  the  commencement  of  the  disease, 
it  is  usually  prescribed  in  the  dose  of  a fluidrachm  or  more,  two  or 
three  times  a day  ; and  with  the  view  of  cutting  it  short  at  the  very 
onset,  it  has  been  proposed  to  administer  as  much  as  from  f.  5ij  to 
f.  5j’,  for  a dose. 

Occasionally,  it  is  administered  in  the  form  of  emulsion,  made 
with  mucilage,  not  too  thick  ; or  yolk  of  egg, — the  vehicle  being  cin- 
namon, peppermint  or  other  aromatic  water. 

PILTLiE  COPA'IBT,  PILLS  OF  COPA'IBA.  {Copaib.  §ij  ; Magnes.  recente 
prffiparat.  ; mix  and  set  aside,  till  the  mixture  concretes  into  a pilu- 
lar  mass,  to  be  divided  into  200  pills.)  Each  of  these  pills  contains 
between  four  and  five  grains  of  copaiba,  so  that  from  two  to  six  or 
more  may  be  given  for  a dose,  two  or  three  times  a day. 

In  the  Edinburgh  Pharmacopoeia,  the  Oleum  Copaiba::  is  officinal. 
This  is  preferred,  by  some,  to  any  preparation  of  copaiba.  1 he 
usual  dose  is  from  ten  to  twenty  drops,  but  Dr.  Pereira  states,  that 
he  has  known  f.  ^ij  taken  at  once  without  any  injurious  conse- 
quences. It  may  be  dropped  on  a lump  of  sugar  ; but  it  is  not  much 
used  in  this  country. 

Capsules  made  of  gelatin  and  inclosing  copaiba  have  been  intro- 
duced, with  the  view  of  obviating  the  taste.  Each  of  these  usually 
contains  about  ten  grains  of  the  copaiba;  and  is  of  a size,  which  can 
generally  be  swallowed  without  difficulty.  The  capsule  is  digested. 
The  process  for  their  formation  is  a secret. 

Copaiba  has  also  been  administered  in  enema,  and  it  is  affirmed 
on  good  authority,  that  of  M.  Velpeau, that  thisform  maybe  substituted 
in  all  cases,  in  which  its  employment  is  considered  to  be  indicated. 
The  author  has  never  used  it  in  this  manner.  It  has  been  proposed 
to  introduce  the  gelatinous  capsules  into  the  rectum,  but  it  is  not 
easy  to  see,  why  a comparatively  expensive  form  of  preparation 
should  be  employed, — seeing  that  the  reasons,  which  suggested  the 
use  of  the  capsules,  cannot  apply  to  the  administration  of  copaiba  by 
the  rectum. 

35.  O'LEUM  CAJUPU'TI.  — CAJ/EPUT  OIL. 

Cajeput  oil  is  the  volatile  oil  of  the  leaves  of  Melaleu'ca  cajupu'ti; 
Sex.  Syst.  Polyadelphia  Icosandria;  Nat.  Ord.  Myrtacese.  It  is  in 
the  secondary  list  of  the  Pharmacopoeia  of  the  United  States. 

The  species  of  melaleuca,  from  which  the  oil  is  obtained,  is  a 
native  of  the  Moluccas.  The  oil  is  procured  from  the  leaves  by 
distillation,  chiefly  at  Amboyna  and  Bourou,  and  is  usually  imported 
from  India  in  green  glass  bottles,  similar  to  long  necked  beer  bottles. 

VOL. I. — 41 


482 


SPECIAL  EXCITANTS. 


In  the  year  1834,  it  was  much  extolled  in  England  in  cases  of  cholera, 
in  consequence  of  which  a great  demand  was  caused  for  it,  and  the 
price  rose  from  two  to  fourteen  shillings  an  ounce.  Various  imi- 
tations accordingly  appeared  in  the  market.  One  of  these  consisted 
of  oil  of  rosemary,  flavoured  with  camphor  and  oil  of  cardamom,  and 
coloured.  (Pereira.)  It  would  not  seem,  however,  that  it  is  often 
adulterated. 

The  appearance  of  the  oil  is  limpid,  and  of  a green  colour;  but, 
when  rectified,  it  is  colourless.  Its  odour  is  strong  and  penetrating, 
and  resembles  that  of  a combination  of  camphor,  rosemary  and  carda- 
mom. The  taste  is  warm  and  pungent. 

Like  the  other  essential  oils,  cajeput  oil  is  excitant;  but  as  its 
impression  is  more  powerful  on  the  gustatory  nerves  than  the  aro- 
matic oils  in  general,  it  has  been  employed,  likewise,  as  an  excitant 
antispasmodic.  It  acts  as  a diffusible  stimulant,  and  hence  is  adapted 
not  only  for  cases  of  flatulent  colic  and  tormina,  like  the  essential 
oils  in  general,  but  both  in  India  and  in  Europe  and  this  cotmtryhas 
been  used  in  low  protracted  fevers,  and  in  paralytic  affections:  it  is 
not  much  employed,  however,  and  appears  not  to  be  possessed  of 
any  virtues  that  especially  recommend  it  as  an  internal  excitant.  As 
a local  excitant,  it  is  more  frequently  used  ; — in  cases,  for  example, 
of  paralysis  of  the  tongue;  and  is  introduced  into  the  hollow  of  the 
tooth,  in  carious  odontalgia.  It  is,  likewise,  used  as  an  embrocation, 
when  mixed  wdth  an  equal  portion  of  olive  oil,  in  chronic  rheu- 
matism, and  painful  affections  in  general,  local  paralysis,  &c.;  but 
even  for  this  purpose,  it  does  not  appear  to  possess  any  virtues  over 
other  excitant  agents  — as  the  terebinthinates. 

The  dose  of  the  oleum  cajuputi  is  from  one  to  five  drops  or  more, 
on  sugar,  or  formed  into  a mixture. 

36.  SUC'CINUM.  — AMBER. 

Amber  is  found  in  various  parts  of  the  world,  but  the  principal 
portion  of  that  which  is  met  with  in  commerce  is  cast  ashore  on  the 
coast  of  the  Baltic  between  Kiinigsburg  and  Memel.  It  is  supposed 
to  be  disengaged  from  lignite  by  the  action  of  the  sea.  It  has  been 
found  in  Maryland  and  New  Jersey,  — in  the  former  state,  associated 
with  iron  pyrites  and  lignite.  The  amber,  however,  which  is  used 
in  this  country,  is  imported  from  the  shores  of  the  Baltic.  (Wood  & 
Bache.) 

Amber  usually  occurs  in  irregularly  shaped  pieces,  of  a pale  golden 
yellow,  but,  occasionally,  of  a reddish-brown,  and  even  deep-brown 
colour.  It  is  insipid,  and  inodorous,  except  when  heated  or  rubbed, 
when  it  exhales  a peculiar,  aromatic,  not  disagreeable  smell.  It  is 
usually  translucent;  at  times,  opaque  or  transparent.  Its  specific 
gravity  is  about  1.078.  It  is  brittle,  having  a conchoidal  fracture. 
It  is  insoluble  in  water,  and  very  slightly  acted  on  by  alcohol. 

When  subjected  to  examination,  its  proximate  constituents  are 
found  to  be  volatile  oil,  two  resins,  a bituminous  substance,  and  a 
peculiar  acid,  called  the  succinic. 


SUCCINUM. 


483 


Amber  is  possessed  of  excitant  properties,  and  was  formerly  given 
in  the  dose  of  10  grains  to  9j  in  powder.  It  is  never,  however,  used 
in  this  country,  except  in  pharmacy  and  the  arts. 

0'LEU)I  SUC'CINI,  OIL  OP  AMBER.  [Succin.  in  pulv.  q.  s.  Put  the 
amber,  previously  mixed  with  an  equal  weight  of  sand,  into  a glass 
retort,  which  is  to  be  only  half  filled;  distil  by  means  of  a sand  bath, 
with  a gradually  increasing  heat,  an  acid  liquor,  an  oil,  and  a con- 
crete acid  impregnated  with  oil.  Separate  the  oil  from  the  other 
matters,  and  keep  it  in  well  stopped  bottles.) 

O'LEUM  SUC'CINI  REGTIFICA'TUM, REC  TIFIED  OIL  OF  AMBER.  {01.  succin.  Oj  ; 
Aquce  Ovj.  Distil  until  four  pints  of  the  water  have  passed  with  the 
oil  into  the  receiver  ; then  separate  the  oil,  and  keep  it  in  well- 
stopped  bottles. 

Oil  of  amber,  as  found  in  the  shops,  has  a strong,  peculiar 
odour,  and  a pungent  acrid  taste.  It  is  nearly  colourless,  when  first 
redistilled,  but  gradually  becomes  brown.  It  is  soluble  in  absolute 
alcohol  in  all  proportions,  and  imparts  its  properties,  in  some  degree, 
to  water. 

It  is  a nauseous  excitant,  and  possesses  the  usual  properties  of  the 
essential  oils  ; but  on  account  of  the  powerful  impression  it  makes 
on  the  gustatory  nerves  also,  it  has  been  prescribed  as  an  anti- 
spasmodic,  in  the  dose  of  from  tr\^ij  to  n\^x. 

It  is  occasionally  used  as  a rubefacient,  in  paralysis,  chronic  rheu- 
matism, and  wherever  excitant  embrocations  are  indicated. 

Succinic  Acid,  obtained  in  the  distillation  of  the  oil  of  amber, 
possesses  similar  properties  to  the  latter,  and  is  officinal  in  the  Dublin 
Pharmacopoeia.  It  was  at  one  time  used  as  an  excitant  in  rheuma- 
tism, but  is  now  never  employed. 

Besides  the  vegetable  excitants  already  mentioned,  the  Pharma- 
copoeia of  the  United  States  has  the  following  in  its  secondary 
list. 

37.  Cata'ria,  Catnep.  The  leaves  of  JYep’eta  CataWia.^  Catnep 
or  Catmint ; Sex.  Syst.  Didynamia  Gymnospefmia  ; Nat.  Ord. 
Labiatm ; are  well  known  in  the  United  States,  and  much  used  in 
domestic  practice.  They  have  a strong,  peculiar  odour,  and  a bitter, 
aromatic  taste,  their  properties  being  mainly  dependent  upon  essen- 
tial oil.  Catnep  readily  yields  its  virtues  to  water,  and  hence  the 
infusion  — catnep  tea  — is  the  form  in  which  it  is  usually  given. 

Catnep  tea  is  a common  domestic  remedy  in  cases  of  colic  in 
infants,  and  some  nurses  are  in  the  habit  of  feeding  them  upon  it  for 
the  first  day  or  two.  It  is  also  used  in  cases  of  amenorrhoea.  It  is 
scarcely  ever  prescribed  by  the  physician. 

38.  Heracle'um,  Masterwort.  The  root  of  Heracle'um  lana’tum., 
sometimes  called  Cow-parsnip ; Sex.  Syst.  Pentandria  Digynia ; 
Nat.  Ord.  Umbelliferse,  is  a common  umbelliferous  plant,  from  Ca- 


484 


SPECIAL  EXCITANTS. 


nada  to  Pennsylvania,  which  flowers  in  June.  The  root  resembles 
parsley,  has  a strong  disagreeable  odour,  and  an  acrid  taste.  It  is 
excitant  when  applied  to  the  skin. 

Masterwort  is  an  excitant,  and  has  been  used  as  such  in  cases  of 
want  of  tone  in  the  stomach,  accompanied  by  flatulence.  It  has 
likewise  been  prescribed  in  epilepsy,  accompanied  by  the  same  gas- 
tric condition.  It  may  be  given  in  powder  or  infusion.  The  author 
has  never  used  it. 

39.  Solida'go,  Golden  Rod.  The  leaves  of  SoUda'go  odo’ra^  or 
sioeet-scented  Golden  Rod  ; Sex.  Syst.  Syngenesia  superflua  ; Nat. 
Ord.  Compositse  Corymbiferse ; a plant,  which  grows  in  woods  and 
fields  throughout  the  United  States,  and  flowers  in  September,  have 
an  agreeable  fragrant  odour.  They  yield  on  distillation  a volatile 
oil,  which  possesses  the  taste  and  aroma  of  the  plant  in  a high  de- 
gree, and  on  which  its  therapeutical  virtues  are  dependent. 

Golden  rod  has  all  the  excitant  virtues  of  the  aromatic  herbs,  — 
being  carminative,  and  an  excitant  diaphoretic  when  given  in  warm 
infusion  ; in  which  form  it  is  also  administered  as  an  excitant  to  the 
gastric  functions.  An  essence,  made  by  dissolving  the  essential  oil 
in  dilute  alcohol,  is  used  in  the  Eastern  States  as  a remedy  in  com- 
plaints arising  from  flatulence,  and  as  a vehicle  for  disagreeable  me- 
dicines of  various  kinds.  The  dried  flowers  are  said  to  be  a sub- 
stitute for  common  tea. 

40.  AL'COHOL. 

Alcohol,  in  pharmacy,  means  rectified  spirit,  of  the  specific  grayity 
0.835 ‘.  — dilute  alcohol j AL'COHOL  DILU'TUM  consists  of  equal  portions, 
by  measure,  of  alcohol  and  distilled  water.  Its  specific  gravity  is 
0.935.  These  are  the  menstrua,  which  are  employed  in  the  forma- 
tion of  tinctures  and  other  preparations,  referred  to  in  the  course  of 
the  present  work.  In  this  place,  the  use  of  the  various  alcoholic 
liquors,  as  excitants,  has  to  be  treated  of.  These  may  be  divided 
into  three  classes  ; Ardent  Spirits,  Wines,  and  Malt  Liquors. 

a.  ARDENT  SPIRITS, 

Ardent  spirits  are  obtained  from  the  distillation  of  vinous  liquids  ; 
and  the  resulting  spirit  differs  according  to  the  precise  vinous  liquid 
that  may  be  employed  in  the  distillation.  For  example,  the  spirit 
obtained  from  the  distillation  of  the  fermented  juice  of  the  grape  is 
Brandy;  that  which  is  obtained  from  molasses  is  Rum;  that  from 
a fermented  infusion  of  grain.  Corn  spirit  : from  one  of  rice  or  tod- 
dy, Arrack  ; from  peach  juice  fermented.  Peach  Brandy  ; from 
cider  fermented,  Apple  Brandy  ; whilst  Gin,  Hollands,  Scotch 
and  Irish  Whisky,  are  corn  spirit  flavoured.  All  these  contain 
various  proportions  of  alcohol,  volatile  oil,  water  ; and,  frequently  — 
as  in  brandy  and  rum  — colouring  matter,  — the  volatile  oil  commu- 
nicating to  the  particular  spirit  the  aroma  by  which  it  is  distinguished. 
These  different  spirits  vary  greatly  from  each  other,  as  to  the  quantity 


ALCOHOL. 


485 


of  alcohol  which  they  contain.  From  experiments  on  some  of  them 
by  Mr.  Brande,  the  following  was  the  average  quantity  s.  g.  0.825, 
obtained  at  60°  Fahr. 

Alcohol  hy  measure. 

100  parts  by  measure  of 

Brandy  contain  ■ 55.39 

Rum  53.68 

Gin  ‘‘  51.60 

b.  WINES. 

Of  the  varieties  of  wine  in  regard  to  their  dietetic  uses,  and  the 
marked  differences  that  exist  between  them,  the  author  has  tretaed 
at  length  in  another  work,  to  which  the  reader  is  referred^  (Human 
Healthy  p.  308,  Philad.,  1844.)  It  will  be  sufficient  here  to  point 
out  their  relative  qualities  as  excitants.  When  subjected  to  analysis, 
they  afford  nearly  the  same  products.  They  contain  much  water  ; 
alcohol  in  variable  quantity ; mucilage  ; tannic  acid,  a blue  colour- 
ing matter,  which  becomes  red,  when  it  unites  with  acids  ; a yellow 
colouring  matter;  bitartrate  of  potassa;  tartrate  of  lime;  acetic 
acid,  and,  at  times,  other  salts,  — as  chloride  of  sodium,  and  sul- 
phate of  potassa.  It  is  to  the  alcohol  that  they  owe  their  strength  ; 
the  more  abundant  it  is,  the  more  generous  the  wine.  The  mucilage 
communicates  no  particular  property  to  them  ; the  tannic  acid  gives 
them  a kind  of  roughness,  and  the  power  of  being  clarified  by  a 
solution  of  glue,  or  of  white  of  egg  ; the  bitartrate  of  potassa,  and 
the  acetic  acid  give  them  tartness  ; so  that  they  acquire  value  by  being 
kept,  not  only  because  their  principles  undergo  modification  in  their 
combination,  but  because  tartar  is  deposited. 

The  following  table  was  drawn  up  by  Mr.  Brande  from  the  results; 
of  his  experiments  on  various  wines.  It  is  proper,  however,  to  re- 
mark, that  many  of  them  were  prepared  expressly  for  the  London 
market,  and  are  more  brandied  or  “ reinforced”  than  the  same  va- 
rieties sold  in  the  United  States.  This  is  strikingly  the  fact  with 
port.  Dr.  Henderson,  too,  has  remarked,  that  some  of  the  wines, 
analysed  by  Mr.  Brande,  were  mixed  with  a considerable  quantity 
of  adventitious  alcohol.  His  additions  and  corrections  have  the 
letter  H.  affixed. 

Proportions  of  Alcohol,  S.  G.  0.825,  in  one  hundred  parts  by  measure  of  the  folloxoing 
ivines,  and  malt  and  spirituous  liquors. 


1.  Lissa, 

. ■ 26.47 

26.  Malmsey  Madeira, 

16.40 

do. 

- 

24.35 

27.  Lunel,  .... 

15.52 

Average,  - 

(a)  25.41 

28.  ScLeraaz,  - 

15.52 

2.  Raisin  Wine, 

26.40 

29.  Syracuse,  - 

15.2a 

do. 

- 

25.77 

30  Sauterne,  - 

1^.12 

do. 

- 

23.20 

3U  Burgundy  ... 

16.60 

Average 

- ' 2.5.12 

do.  .... 

1 5.2^. 

3.  Marsala, 

- 

2,6.03 

do.  - - - - 

14  53 

do. 

- 

25.05 

do.  . . - - 

ll.95i 

Average 

- {b)  25.00 

Average,  - 

14.57 

41* 


Alcohol  hy  measure. 

100  parts  by  measure  of 

Whisky  (Scotch)  54.32 

Whisky  (Irish)  53.90 


486 


SPECIAL  EXCITANTS. 


4.  Port — average  of  six  kinds, 

23.48 

do.  — highest, - 

25.83 

do.  — lowest,  - 

21.40 

5.  Madeira,  - 

24.42 

do. 

23.93 

do.  (Sercial,) 

21.45 

do. 

19.24 

Average 

22.27 

6.  Currant  Wine,  - 

20.55 

7.  Sherry, 

1981 

do. 

19.83 

do. 

18.79 

do. 

18.25 

Average, 

19.17 

8.  Tenoriffe, 

19.79 

9.  Colares,  - 

19.75 

10.  Lacliryma  Christi, 

19.70 

1 1.  Constantia  — white. 

19.75 

red, 

(c)  18.92 

12.  Lisbon, 

18.94 

13.  Malaga, 

18.94 

14.  Bucellas  - 

18.49 

15.  Red  Madeira, 

22.30 

do. 

18.40 

Average 

20.35 

16.  Cape  Muscat  - 

18  25 

17.  Cape  Madeira,  - 

22.94 

do. 

20.50 

do. 

18.11 

Average 

20.51 

18.  Grape  Wine 

18.11 

19.  Calcavella, 

19.20 

do. 

18.10 

Average 

18.65 

20.  Vidonia  - 

19.25 

21.  Alba  Flora, 

17.26 

22.  Malaga,  - 

17.26 

23.  White  Hermitage 

17.43 

24.  Roussillon 

19.00 

do. 

17.26 

Average, 

18.13 

25.  Claret, 

17.11 

do. 

16,32 

do. 

14.08 

do.. 

12.91 

Average, 

(d)  1.5.10 

(a)  15.90  H.  (b)  18.40  H. 


32.  Hock,  - 

14.37 

do.  - - - 

13.00 

do,  (old  in  cask,) 

8.88 

Average,  - 

12.08 

Rudesheimer,  (1811) 

- H.  10.72 

do.  (1800)  - 

- H.  12.22 

Average, 

- H.  11.47 

Johannisberger,  - 

- H.  8.71 

33.  Nice,  ... 

14.63 

34.  Barsac,  - 

13.86 

35.  Tent,  ... 

13.30 

36.  Champagne,  (still) 

13.80 

do.  (sparkling) 

12.80 

do.  (red) 

12.56 

do.  - - - 

1 1 .30 

Average,  - 

12.61 

37.  Red  Hermitage, 

12.32 

38.  Vin  de  Grave,  - 

13.94 

do.  - - - 

12.80 

Average,  - 

13.37 

39.  Frontignac, 

12.79 

40.  Cote  Rotie, 

12.32 

41.  Gooseberry  Wine, 

11.84 

42.  Orange  Wine  — average  of) 

six  samples  made  by 

a^  11.26 

London  manufacturer, 

43.  Tokay,  ... 

9.88 

44.  Elder  Wine, 

9.87 

45.  Rhenish  Wine, 

- H.  8.71 

46.  Cider  — highest  average. 

9.87 

lowest, 

5.21 

47.  Perry  — average  of  4 sam 

pies,  7.26 

48.  Mead, 

7.32 

49.  Ale,  (Burton,) 

8.88 

do.  (Edinburgh.) 

6.20 

do.  (Dorchester,) 

5.56 

Average,  - 

6.87 

50.  Brown  Stout,  - 

6.80 

51.  London  Porter,  (average,) 

4 20 

do.  Small  Beer  (average,)  1.28 

52.  Brandy,  - 

53.39 

53.  Rum,  ... 

53.68 

54.  Gin,  ... 

51.60 

55.  Scotch  Whisky, 

54.32 

56.  Irish  do. 

- '53.90 

(c)  14.50  H.  (</)  12.91  H. 


All  wines  are  necessarily  excitant  by  reason  of  the  alcohol  which 
they  contain,  but  some  are  more  so  than  others.  There  are  but  few, 
however,  which  are  employed  therapeutically,  as  excitants.  These 
are  chiefly  Sherry,  Madeira  and  Port  ; the  first  being  the  only 
one  that  is  officinal — the  VINUM  of  the  Pharmacopoeia  of  the  United 
States  — on  account  of  its  greater  uniformity,  and,  therefore,  better 
adaptation  for  pharmaceutical  purposes  : it  is  the  Vinum  Album 
Hispanicum  of  the  British  pharmacopoeias  ; is  almost  wholly  free 
from  acidity,  and  consequently  well  adapted  for  the  dyspeptic  and 
gouty.  Madeira  wines  are  more  acid  ; and  those  of  Oporto  or  Port 


WINES. 


487 


abound  in  astringency  ; they  are,  therefore,  preferred  in  diseases,  in 
which  an  astringent  and  excitant  agency  is  needed.  They  are  very 
apt  to  disagree  with  the  dyspeptic,  owing,  perhaps,  to  the  gallic 
acid  which  they  contain.  The  brisk  wines  of  Champagne  ; the 
heady  wines  of  Burgundy  ; the  light  wines  of  Bordeaux,  and  of 
the  Rhine  and  Moselle,  are  not  often  given  with  us  as  excitants  ; 
yet  Dr.  Henderson  affirms,  that  in  certain  species  of  fever,  accom- 
panied by  a low  pulse,  and  great  nervous  exhaustion,  they  have 
been  found  to  possess  considerable  efficacy,  and  may  be  given  with 
more  safety  than  most  other  kinds. 

C,  MALT  LIQUORS. 

Malt  liquors  differ  from  wines  chiefly  in  the  following  paints. 
They  contain  a much  greater  proportion  of  nutritive  matter,  and  less 
alcohol ; but  they  have,  in  addition,  a peculiar  bitter  and  perhaps 
narcotic  principle,  derived  from  the  hop.  Without  the  hop,  the  ale 
would  not  keep,  especially  that  intended  for  the  warmer  climates  ; 
and  hence  the  pale  ale^  intended  for  the  India  market,  is  always 
made  intensely  bitter  with  the  hop.  Independently  of  the  flavour 
and  tonic  properties,  which  hops  communicate,  they  precipitate  by 
means  of  their  astringent  principle,  the  vegetable  mucilage,  and 
thus  remove  from  the  beer  the  active  principle  of  its  fermentation  ; 
consequently,  without  hops,  malt  liquors  would  have  to  be  drunk 
either  new  and  ropy,  or  old  and  sour.  (Paris.) 

Malt  liquors  are  unquestionably  nutritive,  where  they  agree  ; and 
in  the  system  of  training”  for  athletic  exercises,  which  consists  in 
raising  the  powers  of  the  individual  to  the  full  extent  of  which  he 
is  capable,  about  three  pints  a day  of  mild  home-brewed  ale  are  re- 
commended for  drink.  Malt  liquors  do  not  digest  well,  however, 
with  those  of  weak  powers.  The  extractive  is  apt  to  produce  flatu- 
lence and  heartburn. 

In  regard  to  alcohol,  it  is  rarely  administered  internally  as  an  ex- 
citant. When  it  is  indicated,  some  form  of  ardent  spirit  is  usually 
chosen;  and  of  these  brandy  is  most  commonly  selected.  Fre- 
quently, however,  in  remote  country  situations,  it  is  not  to  be  met 
with.  In  such  case,  whisky,  or  peach  or  apple  brandy  is  employed. 
In  small  quantities,  it  is  taken  in  certain  forms  of  dyspepsia,  espe- 
cially where  articles  difficult  of  digestion  have  been  eaten,  and  gas- 
trodynia  results.  Occasionally,  too,  it  checks  sickness  of  the  sto- 
mach, especially  sea-sickness  ; although  no  permanent  good  effect 
can  be  expected  in  the  last,  until  the  individual  becomes  accustomed 
to  the  motion  of  the  vessel.  In  the  latter  stages  of  fever,  and  in 
adynamic  conditions  of  all  kinds,  it  is  much  employed  ; but  in  fever 
it  is  less  adapted  than  wine,  — the  stimulus  of  the  latter  being  more 
permanent  and  manageable.  It  may  be  given  in  such  cases  in  the 
form  of  toddy,  or  spirit  and  water  sweetened,  or  in  that  of  milk 
punch,  where  the  stomach  will  bear  it ; but  care  must  be  taken  not 
to  hurry  too  much  the  organic  actions.  In  old  drinkers,  a small  al- 


488 


SPECIAL  EXCITANTS. 


lowance  — two  to  four  ounces  in  the  twenty-four  hours  — is  some- 
times advisable  in  the  course  of  ataxic  and  adynamic  diseases,  but 
the  quantity  should  be  gradually  diminished,  until  it  is  abandoned. 
It  need  scarcely  be  said,  that  the  case  must  be  bad  indeed,  in  which 
the  hopes  of  the  practitioner  are  placed  on  the  excitement,  which 
alcohol  is  capable  of  inducing.  It  may  be  a question,  indeed, 
whether  it  be  not  calculated  to  exhaust  the  slight  amount  of  excita- 
bility still  existing  in  the  system.  Perhaps  in  delirium  tremens  it 
is  most  largely  depended  upon  by  some  practitioners  ; yet,  — as 
elsewhere  remarked,  — the  disease  is  certainly,  in  the  generality  of 
cases,  best  treated  eclectically.  The  recuperative  powers  of  the  sys- 
tem are  usually  sufficient  to  restore  the  individual.  Some,  however, 
give  ardent  spirit  freely  — an  ounce  or  two  every  hour  — and, 
doubtless,  under  this  stimulation,  the  individual  may  be  restored  to 
the  condition  in  which  he  was  prior  to  the  withdrawal  of  the  stimu- 
lus which  gave  rise  to  the  disease. 

Externally,  alcohol  is  much  employed  as  an  excitant  to  inflamed 
parts,  where  the  hypersemia  affects  the  skin  more  especially,  — as  m 
erysipelas,  burns  and  scalds  when  the  epidermis  is  not  removed, 
and  in  sprains  and  bruises.  Not  only  does  it  act  as  an  excitant  in 
such  cases,  when  first  applied,  but  during  its  evaporation  it  causes 
an  agreeable  sense  of  coolness  in  the  affected  parts.  Largely  diluted 
with  water,  it  forms  an  excellent  collyrium  in  chronic  conjunctivitis. 

Owing  to  its  excitant  properties,  when  applied  to  vessels  that  are 
the  seat  of  hemorrhage,  it  coagulates  the  albumen,  at  the  same  time 
constringing  the  vessels,  and  thus  acts  as  a styptic ; and  it  is  occa- 
sionally used  as  an  excitant  injection  for  the  radical  cure  of  hydro- 
cele. Rubbing  the  limbs  or  body  with  spirit  — as  with  whisky — is 
not  unfrequently  had  recourse  to,  in  order  to  arouse  the  powers  of 
the  system  generally  or  those  of  some  internal  organ. 

In  regard  to  the  therapeutical  use  of  wine,  it  is  decidedly  the  best 
stimulant  in  long  protracted  fevers.  It  is  much  more  permanent  in 
its  action  than  ardent  spirit,  and  its  strength  can  be  regulated,  so 
that,  under  careful  watching,  no  bad  effects  can  easily  result  from  its 
use.  The  phenomena,  that  render  it  advisable  in  fevers,  are  — 
signs  of  great  prostration  ; and  those  that  show  that  it  is  proper  for 
the  patient  are,  its  being  relished  by  him ; agreeing  with  the  sto- 
mach, not  increasing  the  heat  of  the  skin,  or  dryness  of  the  tongue  ; 
and  the  general  feelings  and  condition  becoming  ameliorated. 

Any  of  the  three  stronger  wines  — Sherry,  Madeira  or  Port  — 
may  be  prescribed  ; but  unless  there  be  a morbid  complication,  which 
requires  the  astringency  of  the  last.  Sherry  is  to  be  preferred.  It 
may  be  given  mixed  with  an  equal  quantity  of  water,  and  sweetened, 
if  the  patient  prefers  it,  or  in  the  form  of  unne  whey.  Four  ounces, 
in  the  course  of  the  twenty-four  hours,  may  be  prescribed,  should 
doubt  exist  as  to  the  propriety  of  its  administration  ; and  if  it  agrees, 
the  quantity  may  be  gradually  increased.  In  highly  adynamic  states, 
as  in  malignant  typhus,  a bottle  or  two  may  be  given  in  the  day  with 
manifest  advantage.  Should  it  appear  to  disagree,  it  may  be  dis* 


iETHER  SULPHURICUS. 


489 


continued  gradually.  Great  caution  is,  however,  needed  in  the  ex- 
hibition of  this,  as  well  as  of  other  excitants,  in  fever ; and  upon  the 
whole  we  may  say  of  it  — with  a modern  writer.  Dr.  A.  T.  Thom- 
son — as  of  every  other  potent  article,  that  ‘‘  it  is  a medicine  or  a 
poison,  according  to  the  discretion  and  moderation  with  which  it  is 
used,  and  the  skill  and  judgment  which  direct  its  medicinal  employ- 
ment.” 

Malt  liquors  are  not  much  employed  therapeutically  as  excitants  ; 
but  bottled  porter  is  occasionally  given  in  adynamic  conditions, 
which  fall  under  the  care  of  the  surgeon  more  especially,  as  in  local 
gangrene,  sloughing  ulcers,  &c.  Occasionally,  this  liquor  agrees 
with  the  dyspeptic, — apparently  owing  to  the  carbonic  acid,  which 
it  gives  off, — when  the  still  malt  liquors  could  not  be  taken  with 
impunity. 

41.  ^THER  SULPHU'RICUS.— SULPH'URIC  ETHER. 

Ethers  are  formed  by  the  action  of  various  acids  on  alcohol ; and 
they  differ  in  their  sensible,  but  not  materially  in  their  medical  pro- 
perties, according  to  the  acid  employed.  Hence,  but  two  are  con- 
tained in  the  Pharmacopoeia  of  the  United  States  — the  Sulphuric 
and  the  JYitric. 

Sulphuric  ether  is  formed  by  the  action  of  sulphuric  acid  on  alco- 
hol ; but  when  prepared  in  this  manner,  the  distilled  liquor  contains 
alcohol,  water,  sulphurous  acid,  and  oil  of  wine.  To  rectify -it, 
potassa,  or  carbonate  of  potassa  was  directed  to  be  added  to  it,  and 
that  it  should  be  redistilled.  The  product  was  the  ^Ether  Sulphu'- 
Ricus  Rectifica'tus,  of  the  former  edition  of  the  Pharmacopoeia  of 
the  United  States,  and  of  the  British  Colleges.  In  the  last  edition, 
however,  of  the  Pharmacopoeia  of  the  United  States,  the  addition  of 
the  potassa  is  a part  of  the  process,  so  that  the  iETHER  SULPHU'RICUS  of 
that  edition  corresponds  with  the  ^fJier  Sulphu'ricus  Rectifica’tus  of 
former  editions.  In  this  state  it  wholly  evaporates  in  the  air,  and, 
w'hen  agitated  with  an  equal  bulk  of  water,  loses  about  one  tenth  of 
its  volume. 

The  theory  of  etherification  is  very  complex,  and  has  occupied  the 
attention  of  many  chemists  of  distinction.  Alcohol,  in  its  pure  state, 
is  generally  regarded  as  a compound  of  ether  and  water ; conse- 
quently, if  the  water  be  separated  by  any  agency,  as  by  that  of  sul- 
phuric acid,  the  ether  will  remain  ; but  for  the  mode  in  which  this, 
and  the  various  accessory  reactions  are  effected,  the  reader  is  referred 
to  the  works  of  Liebig,  Turner,  Pereira,  and  others. 

Sulphuric  ether  is  a colourless,  transparent  fluid,  of  a peculiar 
penetrating  and  fragrant  odour,  and  a hot  pungent  taste,  followed  by 
a sense  of  coolness.  The  specific  gravity  of  that  of  the  United  States 
Pharmacopoeia  is  0.750  ; hence  it  is  extremely  volatile.  It  boils  at 
about  the  temperature  of  96°.  When  pure  and  recently  prepared,  it  is 
neither  acid  nor  alkaline,  but  by  exposure  to  air  and  light  it  absorbs 
oxygen,  by  which  acetic  acid  and  water  are  formed.  It  is  sparingly 
soluble  in  water, — ten  volumes,  as  already  remarked,  dissolving  in  one 


490 


SPECIAL  EXCITANTS. 


of  it.  By  alcohol  it  is  dissolved  in  all  proportions.  It  dissolves  the 
volatile  oils,  and  most  of  the  fatty  and  resinous  substances. 

The  action  of  ether  on  the  economy  is  more  diffiisibly  excitant 
than  that  of  any  other  article,  and,  accordingly,  its  operation  is  very 
transient.  Hence,  it  is  better  adapted  than  alcohol,  where  the  ob- 
ject is  to  stimulate  the  stomach,  without,  at  the  same  time,  augment- 
ing the  action  of  the  heart  and  arteries.  Accordingly,  it  is  given 
with  great  advantage  in  severe  gastrodynia  and  flatulence.  In  large 
doses,  it  produces  intoxication  like  alcohol,  and,  in  still  larger,  nar- 
cosis. It  appears  to  pass  readily  into  the  circulation,  and  is  co- 
piously exhaled  with  the  pulmonary  transpiration.  Like  alcohol,  it 
has  been  detected  in  the  brains  of  those  who  have  died  after  it  has 
been  exhibited  in  large  quantity. 

' The  author  has  treated  elsewhere  of  the  use  of  sulphuric  ether  in 
spasmodic  diseases,  for  which  it  is  better  adapted,  than  for  diseases 
of  debility ; although  it  is  often  given  in  the  latter,  when  the  powers 
of  life  are  flagging ; and,  too  often,  where  but  little  expectation  of 
benefit  can  be  expected  from  the  use  of  any  remedies. 

The  dose  is  f.  -^ss  to  f.  5ij,  incorporated  with  water  by  rubbing 
it  with  spermaceti,  in  the  proportion  of  two  grains  to  each 
fluidrachm  of  ether. 

The  SPIR'ITUS  E'THERIS  SUIPHU'RICI  COMPOS 'ITUS,  or  COMPOUND  SPIRIT  OP 
ETHER,  (p.  380,)  and  the  SPIR'ITUS  Jl'THERIS  NI'TRICI,  or  SPIRIT  OF 
NITRIC  ETHER,  (p.  273,)  may  be  used  in  the  same  cases  as  the  sulphuric 
ether.  By  reason,  however,  of  their  containing  more  alcohol,  they 
are  less  diffusible  in  their  action,  and,  therefore,  better  adapted  for 
cases  in  which  a more  permanent  stimulus  is  needed.  The  dose  is 
f.  3SS  to  f.  3iij,  repeated  as  the  case  may  seem  to  require. 

42.  CREASO^TUM.—CRE'ASOTE. 

Creasote,  in  the  Pharmacopoea  of  the  United  States,  is  defined  to 
be  a peculiar  substance  obtained  from  tar.”  It  is  produced  artifi- 
cially during  the  destructive  distillation  of  organic  substances,  and  is 
found  in  pyroligneous  acid,  Dippel’s  oil,  wood  smoke,  &c.  Its 
most  abundant  source  is  the  tar  or  {pyroligneous  acid,  obtained  from 
the  wood  of  the  birch.  In  the  neighbourhood  of  Edinburgh  it  is  pro- 
cured, according  to  Dr.  Christison,  in  large  quantity,  and  of  fine 
quality,  from  Archangel  Tar.  It  is  not  prepared  by  the  apothecary, 
and,  therefore,  is  not  amongst  the  preparations  in  the  Pharmacopoeia 
of  the  United  States,  (1842,)  but  in  the  list  of  the  Materia  Medica. 
All  the  processes  for  obtaining  it  are  complex  ; many  of  them  are 
given  by  the  author  in  another  work.  ( JYew  Remedies^  4th  edition, 
p.  201,  Philad.  1843.) 

Creasote  is  a colourless,  transparent,  and  oleaginous  liquid,  of  an 
odour  which  is  highly  characteristic.  It  is  entirely  soluble  in  acetic 
acid,  alcohol,  and  caustic  potassa  ; and  coagulates  the  albumen  of 
eggs,  of  the  blood,  and  of  albuminous  fluids.  When  dropped  on 
paper,  and  exposed  to  heat,  it  is  entirely  volatilised,  and  does  not 


CREASOTUM. 


491 


leave  a greasy  stain.  It  is  powerfully  antiseptic,  whence  its  name 
from  ‘‘ flesh,  ” and  ‘‘preserver.”  Its  specific  gravity  is 

generally  stated  at  1037,  as  given  by  Reichenbach,  who  discovered 
it  some  years  ago  ; but  Dr.  Christison  states,  that  he  has  never  found 
it  lower  than  1065,  or  higher  than  1067.  Water  dissolves  -^th  part  of 
it,  and  acquires  a peculiar  acrid  taste,  and  a powerful  smoky  smell, 

. which  is  perceptible  when  the  creasote  only  forms  p^-^^th  part  of  it. 

Creasote,  when  applied  locally,  is  an  unquestioned  irritant. 
When  put  upon  the  tongue,  it  causes  an  excessive  burning  sensation. 
When  applied  to  a part  whence  the  epidermis  has  been  removed,  or 
to  a wound,  — instantaneously,  an  extremely  violent  burning  pain  is 
experienced,  which  is  continued  for  eight  or  ten  minutes,  but,  if  the 
part  be  carefully  washed,  it  gradually  ceases.  The  surface  also  be- 
comes white,  as  if  nitrate  of  silver  had  been  applied  to  it,  owing  to 
the  action  of  the  creasote  on  the  organic  matters.  Given  internally 
in  large  doses,  it  occasions  considerable  irritation  in  the  gastro-enteric 
raucous  membrane;  and,  when  it  destroys,  death  is  preceded  by 
more  or  less  narcosis;  hence  it  has  been  ranked  as  an  acro-narcotic 
poison.  (Christison.)  In  three  experiments  which  were  made  with 
it  on  dogs  by  Dr.  Cormack,  of  Edinburgh,  twenty-five  drops  of 
pure  creasote  were  injected  into  the  veins.  All  the  animals  died  : 
and  in  every  case,  the  following  phenomena  were  observed.  Its 
first  deleterious  action  was  a powerful  one  of  sedation  on  the  heart ; 
the  vital  energies  of  that  viscus  seeming  to  be  instantaneously  para- 
lysed. In  some  instances,  hurried  and  sonorous  respiration  went 
on  for  more  than  a minute  after  the  heart  had  ceased  to  beat.  In 
general,  one  or  two  convulsions,  resembling  the  tetanic,  preceded 
death.  In  every  instance,  the  atony  of  the  heart  immediately  after 
death  svas  very  striking. 

In  the  case  of  a patient  of  the  author,  who  took  ten  drops  of  it  by 
mistake,  great  vertigo,  headache,  and  a sensation  as  if  the  head  were 
about  to  burst  by  expansion,  supervened,  with  vomiting,  and  much 
gastric  distress.  When  taken  for  a length  of  time,  it  appears  to  com- 
municate a blackish-hue  to  the  urine,  and,  in  some  cases,  can  be  de- 
tected in  that  fluid. 

Creasote  is  used  as  an  internal  excitant  in  cases  of  gastrodynia  and  fla- 
tulence of  the  stomach  and  bowels  ; but  itdoes  not  seem  to  possess  any 
advantage  over  the  essential  oils  and  other  diffusible  excitants,  whilst 
it  has  the  objection  of  being  exceedingly  disagreeable.  It  has  been 
tried  — it  is  not  easy  to  see  on  what  principle  — in  diabetes  melli- 
tus ; but  the  encouragement  is  not  great  to  repose  any  confidence  in 
it.  Nor  has  its  efficacy  been  more  marked  in  gouty  and  rheumatic 
cases,  in  which  it  has  been  prescribed  by  some.  Of  its  value  in  in- 
ternal hemorrhages,  mention  has  been  made  under  the  proper  head. 
(See  Astringents.) 

Externally,  it  has  been  used  in  various  cases  as  a topical  excitant, 
— for  example,  in  the  form  of  wash  or  ointment,  in  burns,  in  chafing 
of  the  integuments — intertrigo  ; in  sore  nipples ; chilblains  ; in  fissures 


402 


SPECIAL  EXCITANTS. 


of  the  skin  ; and  ulcers,  especially  of  the  sluggish,  atonic  kind  ; and, 
indeed,  in  every  form  in  which  it  seems  advisable  to  change  the  ac- 
tion of  the  parts  by  an  appropriate  excitant,  — or,  where,  from  the 
offensive  nature  of  the  discharge,  an  antiseptic  or  disinfectant  is  need- 
ed ; in  cancerous  affections  of  the  uterus  and  other  parts  ; in  lupus, 
and  various  other  chronic  cutaneous  affections  ; in  ophthalmia  tarsi ; 
prolapsus  vaginse,  &c.  It  has  likewise  been  applied  in  cases  of 
toothache,  by  means  of  a camel’s  hair  pencil  passed  into  the  hollow 
of  the  tooth,  or  of  cotton  dipped  in  a mixture  of  equal  portions  of 
creasote  and  alcohol.  In  deafness,  connected  with  a deficiency  of 
ceruminous  secretion,  it  has  been  used  with  advantage,  in  the  propor- 
tion of  one  part  of  creasote  to  six  or  eight  parts  of  dive  oil,  or  lard. 
It  may  be  introduced  into  the  meatus  by  means  of  a camel’s  hair 
pencil.  As  a caustic,  it  may  be  applied  undiluted. 

Besides  its  excitant  properties,  it  possesses  others,  w^hich  have 
been  described  in  the  proper  places. 

Creasote  is  sometimes  given  in  the  form  of  pill,  which  greatly 
masks  its  disagreeable  characters.  [Creasot.  tt^^x;  Pulv.  Glycyr- 
rhiz.  5j  ; Mucilag.  acacice,  q.  s.  ut  fiant  pilulee  xx.  Two  for  a dose.) 
Or,  one  or  two  drops  may  be  diffused  by  means  of  mucilage  in  some 
aromatic  water. 

The  strength  of  lotions  may  vary  from  tt\,ij  to  rr^vj  to  the  ounce  of 
water.  The  ordinary  strength  of  Creasote  water  is,  however,  one 
part  of  creasote  to  eighty  of  water.  It  may,  also,  be  added  to  poul- 
tices, in  cases  of  foul  or  gangrenous  ulcers. 

lAWNTUM  CREASO'TI,  OINTMENT  OF  CRE  ASOTE.  {Creasot.  ^ss;  Adi- 
pis,  ^j.)  This  ointment  is  of  a good  strength  for  ordinary  cases  of 
cutaneous  disease.  The  author  has  succeeded  in  removing  lupus, 
and  porrigo  of  the  scalp  by  means  of  it,  after  other  topical  agents 
had  failed. 

43.  AMMO'WIA. 

The  different  preparations  of  ammonia  are  excellent  excitants,  and 
well  adapted  for  the  relief  of  certain  morbid  conditions. 

Ammoni'acal  gas  is  obtained  for  medicinal  purposes  by  the  decom- 
position of  the  Muriate  of  ammonia,  by  means  of  lime,  which  has  a 
stronger  affinity  for  the  chlorohydric  acid  than  the  ammonia,  and 
consequently  displaces  it.  The  ammonia  is  given  off  in  the  gaseous 
state.  It  is  too  excitant,  however,  under  almost  any  form  of  manage- 
ment to  be  employed  therapeutically;  and  as  it  is  very  soluble  in 
water,  it  is  allowed  to  combine  with  that  fluid  and  form  the  officinal 

1.  IIRUOR  AMMOM,  SOLUTION  OF  AMMO'NIA,  or  WATER  OF  AMMO'NIA. 
The  specific  gravity  of  this  preparation  — as  directed  in  the  Pharma- 
copoeia of  the  United  States,  (1842) — is  0.96  ; and  100  grains  of  it 
saturate  30  grains  of  officinal  sulphuric  acid.  It  is  a transparent 
colourless  liquid,  of  a highly  pungent  odour,  and  caustic  alkaline 
taste  ; sometimes,  it  contains  carbonate  of  ammonia,  which  may  be 
detected  by  lime  water,  which  occasions  a milky  precipitate  of  car- 
bonate of  lime,  if  carbonic  acid  be  present,  and  it  effervesces  with 


AMMONIA. 


493 


dilute  acids.  When  exposed  to  the  air,  it  quickly  parts  with  ammo- 
nia, and  also  absorbs  carbonic  acid,  so  that  it  must  be  kept  in  well 
stopped  bottles.  It  unites  wilh  oil,  so  as  to  form  soaps  or  liniments. 

Liquor  ammonise  of  the  United  States  Pharmacopoeia  is  not  often 
prescribed  internally  in  its  uncombined  state.  When  properly  diluted, 
however,  it  may  be  given  in  cases  of  heartburn,  accompanied  by 
atony  of  the  digestive  organs  ; its  alkaline  properties  neutralising  the 
acid  already  in  the  stomach,  whilst  its  excitant  agency  tends  to  pre- 
vent the  generation  of  more.  The  carbonate  of  ammonia  is,  however, 
usually  preferred. 

Liquor  ammoniae  is  held  to  the  nose  in  cases  of  fainting,  that  its 
vapour  may  impress  the  olfactory  nerves  ; and  its  excitant  effects  are 
often,  in  this  way,  beneficial.  It  is  said,  that  an  attack  of  epilepsy 
has  been  prevented  in  this  manner.  It  has  been  occasionally 
used  in  cases  of  asphyxia,  as  from  drowning ; the  epiglottis  being 
touched  with  the  finger,  or  a feather  dipped  in  a little  of  it ; and  it  is 
said  with  success  ; care,  however,  must  be  taken,  lest  the  spark  be 
extinguished  by  it.  It  is  most  commonly  employed  to  induce  rube- 
faction  in  a variety  of  affections,  especially  in  those  of  a rheumatic 
or  neuralgic  nature.  It  has  been  suggested  as  an  excitant  in  amenor- 
rhoea,  and  in  chronic  leucorrhcea,  — a few  drops  being  added  to  milk  ; 
but  it  need  scarcely  be  said,  that  so  powerful  an  excitant  should  be 
used  with  caution.  The  various  preparations  of  ammonia  have  been 
extolled,  too,  in  the  bites  of  poisonous  serpents  and  insects,  and  they 
certainly  are  often  of  decided  advantage. 

The  dose  of  liquor  ammonise  is  from  gtt.  v to  *gtt.  xx  or  xxx, 
properly  diluted  with  milk. 

I LIQUOR  AMMO'NIiE  FOR'TIOR,  STRONG  SOLUTION  OF  AMMO'NIA.  An  aque- 
ous solution  of  ammonia  of  the  specific  gravity  0.882,  is  directed  in 
the  Pharmacopoeia  of  the  United  States  : as,  however,  it  is  prepared 
by  the  druggist,  it  is  not  placed  amongst  the  preparations,  but  in  the 
Materia  Medica  list.  This  stronger  solution  of  ammonia  may  be 
employed  to  make  the  Liquor  AmmonicB  — the  preparation  last  de- 
scribed — by  mixing  one  part  by  measure  of  the  stronger  solution 
with  two  parts  of  distilled  water. 

Strong  solution  of  ammonia  has  been  introduced  into  the  pharma- 
copoeias mainly  on  account  of  its  counter-irritant  properties,  to  excite 
rubefaction  and  vesication  of  the  cutaneous  surface.  When  two  parts 
of  Liquor  ammonicB  are  united  with  one  part  of  suet^  and  one  part  of 
oil  of  sweet  almonds mixture  forms  the  Pommade  ammoniacale 
of  Gondret,  which  has  been  used  for  a long  time  to  excite  a speedy 
revulsion  in  chronic  affections  of  the  brain,  incipient  cataract,  amau- 
rosis, &c.,  as  well  as  to  cauterise  the  integuments  deeply. 

It  also  forms  the  basis  of  the  counter-irritant  or  “ an  tidy  nous  lotions^'' 
of  Granville^  which  were  brought  forward  a few  years  ago  with  high 
pretensions  by  Dr.  Granville,  of  London,  and  in  a manner  not  calcu- 
lated to  enhance  his  professional  reputation.  The  stronger,  and  the 
milder  lotion  were  composed  as  follows  : — 

VOL.  I. — 42 


494 


SPECIAL  EXCITANTS. 


Stronger  ammoniated  lotion.  — K.  Liq.  ammon.  fort.  f.  5X  ; spirit, 
rosmarin.  f.  Jss  ; camphor.  5ij-  — M. 

Milder  ammoniated  lotion.  — R.  Liquor,  ammon.  fort.  f.  ; spirit, 
rosmarin.  f.  ^vj  ; tinct.  camphor,  f. 

The  stronger  of  these  lotions  is  a powerful  agent.  They  are  both 
employed  as  cutaneous  revellents,  and  their  special  application  will  be 
considered  elsewhere.  (See  Revellents.) 

J.  SPIRdTUS  AMMOM,  SPIRIT  OF  AMMOm  Thisprepationismadein  the 
same  manner  as  liquor  ammonise,  by  decomposing  muriate  of  ammo- 
nia by  means  of  lime^  and  causing  the  ammoniacal  gas  to  pass  into 
alcohol  in  place  of  water.  It  is,  therefore,  ammonia  dissolved  in  al- 
cohol, and  possesses  the  properties  of  the  ammoniacal  preparations 
in  general.  It  is  chiefly,  however,  used  in  the  preparation  of  the 
ammoniated  tinctures,  but  may  be  given  as  an  excitant  in  the  dose 
of  20  to  60  drops,  in  a wine-glassful  of  water. 

4.  SPIR'ITUS  AMO'NliE,  AROMATflC  SPIRIT  OF  AMMO™,  (p.  402.) 
The  spirit  of  carbonate  of  ammonia,  in  this  preparation,  is  rendered 
more  agreeable  by  the  addition  of  the  aromatics,  and  is  much  used  in 
faintness  and  flatulence  ; — in  the  former  case,  both  as  an  excitant  held 
to  the  nose  ; and  in  most  cases  administered  internally.  The  dose  is 
the  same  as  that  of  the  spiritus  ammonice. 

L AMO'NIJ:  CAR'BONAS,CAR'BONATE  OF  AMMO  NIA,  called  also  Sal  vo- 
latile and  Hartshorn  salt,  is  prepared  by  subliming  a mixture  of  mu- 
riate of  ammonia 'dXid  chalk.^  (carbonate  of  lime.)  The  muriatic  acid 
lays  hold  of  the  lime,  and  the  carbonate  of  ammonia  sublimes. 

Carbonate  or  sesquicarbonate  (London  Pharmacopoeia)  of  ammonia 
is  in  whitish  translucent  fibrous  masses,  of  a powerfully  ammoniacal 
odour,  and  a pungent  alkaline  and  ammoniacal  taste.  It  is  wholly 
soluble  in  water,  and  entirely  dissipated  by  heat.  When  exposed  to 
the  air,  it  falls  into  powder,  becomes  opaque,  and  loses  ammonia. 
It  forms  soaps  with  oils,  and  is  freely  soluble  in  dilute  alcohol,  but 
very  slightly  so  in  alcohol. 

Carbonate  of  ammonia  possesses  all  the  excitant  properties  of  the 
ammoniacal  preparations,  tempered  by  the  combination  with  carbonic 
acid.  It  is,  therefore,  more  frequently  given  as  an  excitant,  where 
the  object  is  to  support  the  powers,  than  any  of  the  others.  In  long 
protracted  fevers,  particularly  of  the  typhous  class,  it  is  frequently 
prescribed  alone,  or  along  with  other  excitants,  as  wine  whey.  It  is 
also  given  in  heartburn  dependent  upon  an  asthenic  condition  of  the 
digestive  organs.  Under  the  name  smelling  salts,  it  is  in  constant 
domestic  use  in  fainting.  Usually,  in  such  cases,  an  aromatic  oil, 
as  oil  of  bergamot  or  of  lavender,  is  added  ; and  at  times,  its  strength 
is  increased  by  the  addition  of  a little  of  the  stronger  solution  of  am- 
monia. 

The  dose,  as  an  excitant,  is  from  five  to  ten  grains  every  few  hours, 
in  the  form  of  pill,  or  mixed  with  a little  syrup,  whirh  masks  its  taste. 

It  is  sometimes  used,  mixed  with  oil  or  lard,  or  dissolved  in  water, 
. as  a topical  excitant  and  revellent,  in  rheumatic  pains,  &c.,  but  the 


AMMONIiE  MURIAS. 


495 


liquid  preparations  of  ammonia  are  employed  more  readily,  and  quite 
as  satisfactorily. 

Carbonate  of  ammonia  enters  into  the  formation  of  the  Cuprum  am- 
moniatum^  and  the  Liquor  ammonicR  acetatis  of  the  Pharmacopoeia  ol 
the  United  States. 

6.  AMMO'NIJl  MU'RIAS,  MU'RIATE  OF  AMMO'NIA.  Mu'riate  of  ammo'nia, 
Hydrochlorate  or  Chlorohydrate  of  ammonia^  or  Sal  ammoniac^  is  a 
natural  production,  being  found  in  and  near  volcanoes,  and  occasion- 
ally the  salt  of  commerce  has  been  obtained  from  this  source.  It  is 
now,  however,  principally  prepared  by  decomposing  sulphate  of  am- 
monia by  means  of  chloride  of  sodium  or  common  salt ; and  at  the 
present  time,  in  England,  is  manufactured  from  the  impure  ammo- 
niacal  liquors,  obtained  as  secondary  products.  The  various  modes 
for  preparing  it  are  well  given  by  Dr.  Pereira. 

In  this  country,  it  is  obtained  from  abroad  in  two  commercial  va- 
rieties — the  crude  and  the  refined  ; the  former  of  which  is  imported 
from  Calcutta  and  is  used  in  the  arts  ; the  latter  is  derived  from  England. 

As  met  with  in  the  shops,  muriate  of  ammonia  is  white  and  trans- 
lucent ; occurring  generally  in  concavo-convex  pieces,  which  have  the 
shape  of  the  vessel  into  which  the  salt  is  sublimed.  It  is  wholly  vola- 
tilised by  heat,  and  is  dissolved  by  water.  Its  taste  is  saline  and  acrid, 
but  it  is  devoid  of  smell.  It  is  soluble  in  about  three  parts  of  cold, 
and  one  of  boiling  water,  and  cold  is  produced  during  the  solution.  It 
dissolves,  also,  in  alcohol.  Its  specific  gravity  is  1.450. 

Muriate  of  ammonia  is  scarcely  ever  employed  in  this  country  as  an 
internal  agent ; but  in  Germany,  it  is  used  in  the  most  opposite  cases  ; 
some  esteeming  it  to  be  excitant ; others  refrigerant  and  sedative.  It 
is  unquestionably  excitant,  both  when  employed  internally  and  exter- 
nally. As  a lotion,  it  is  sometimes  used  in  cases  of  encephalic  affec- 
tions, owing  to  the  cold  it  induces.  With  such  view,  it  ought,  of 
course,  to  be  applied  at  the  moment  of  solution.  It  need  scarcely  be 
said,  however,  that  we  have  in  iced  water  a far  more  available  and 
effective  application.  As  an  excitant,  it  is  employed  in  cases  of  sprains 
and  contusions  ; in  indolent  tumours,  inflammation  of  the  eyes,  chil- 
blains ; in  chronic  cutaneous  affections,  as  scabies  ; and  as  an  injection 
in  gonorrhoea,  leucorrhoea,  &c.  An  ounce  or  two  of  the  salt  may  be  dis- 
solved in  a pint  of  water,  to  which  an  ounce  or  two  of  alcohol  may  be 
added,  where  it  is  desired  to  apply  it  as  a discutient.  Solutions  of  the 
strength  of  to  5ss  of  the  salt  to  Oj.  of  water,  maybe  used  as  washes 
in  cutaneous  affections,  or  in  injections  in  the  diseases  above 
mentioned. 

In  pleuritic  affections,  according  to  Sir  George  Lefevre,  it  is 
usual  to  combine  the  tartrate  of  antimony  and  potassa  with  it, 
according  to  the  following  formula : — 

E.  Ammon.  Muriat.  ^j. 

Antim.  et  Potass.  Tart.,  gr.  ij. 

Decoct.  Glycyrrhiz.  f.  §vij. 

Syrup.  Althagae,  f.  §j.  M, 


496 


SPECIAL  EXCITANTS. 


A table-spoonful  of  this  mixture  is  given  every  two  hours,  and 
continued  in  spite  of  the  nausea, .and  occasional  vomiting,  which  the 
few  first  doses  seldom  fail  to  produce.  When  prescribed  by  itself, 
with  the  same  view  as  the  nitrate  of  potassa,  Sir  George  Lefevre 
states,  that  as  far  as  his  own  experience  is  concerned,  he  should 
give  it  a decided  preference.  Its  salt  unpleasant  taste,  according  to 
Sir  George,  is  best  disguised  by  liquorice  root  in  the  form  of 
decoction,  or  by  a solution  of  the  extract  in  water.  Generally,  after 
the  first  few  doses,  patients  take  it  without  disgust. 

44.  PHOSTHORUS. 

Phosphorus  is  made  by  adding  sulphuric  acid  to  hone  ashes,  which 
consist  principally  of  phosphate  of  lime.  In  this  way  sulphate  and 
superphosphate  of  lime  are  formed.  Water  is  added  to  this,  and  after 
standing  for  some  time,  the  solution  is  filtered.  It  is  then  evaporated 
until  it  has  the  consistence  of  syrup,  when  it  is  mixed  with  charcoal, 
dried,  and  distilled  in  an  earthen  retort.  By  this  process,  the  char- 
coal abstracts  oxygen  from  the  phosphoric  acid  of  the  superphos- 
phate; the  phosphorus  is  consequently  set  free,  volatilised  and  con- 
densed in  water,  in  a proper  receiver.  It  may  be  purified  by  pressing 
it  through  chamois  leather  under  water.  It  is  afterwards  moulded 
into  cylinders. 

Phosphorus,  when  pure,  is  devoid  of  colour,  but  has  usually  a 
reddish  hue.  It  has  no  taste,  but  has  an  alliaceous  odour;  is  flexible 
at  ordinary  temperatures;  and  of  a specific  gravity  1.77.  It  is  in- 
soluble in  water,  but  soluble  in  ether,  and  in  the  fixed  and  volatile 
oils. 

Phosphorus  is,  in  small  doses,  a powerful  diffusible  excitant;  and 
in  large  doses,  an  acrid  poison.  It  has  been  esteemed  adapted  for 
cases  of  great  prostration  of  the  powers,  no  matter  what  may  be  the 
accompanying  disease.  It  is  very  rarely  used,  however,  in  this 
country.  It  is  affirmed,  from  the  personal  experience  of  A.  Leroy, 
Chenevix,  Bouttatz  and  others,  to  be  aphrodisiac,  and  has  therefore 
been  used  in  the  impotence  of  old  and  debilitated  subjects. 

Phosphorus  is  shown  by  Liebig  to  be  an  essential  constituent  of 
the  neurine,  and  we  shall  not  be  surprised  to  see  it  prescribed  in 
nervous  diseases  particularly,  on  the  hypothesis,  that  want  of  nervous 
power  may  depend  upon  a deficiency  in  the  due  proportion  of  that 
element ! 

Phosphorus  is  generally  administered  dissolved  in  ether  or  oil. 
The  Tinctura  tLtherea  cum  Phosphoro  of  the  French  Codex  con- 
sists of  Phosphorus  4 parts.  Sulphuric  Ether  200  parts,  by  weight. 
Each  ounce  contains  about  four  grains  of  phosphorus ; and  the  dose 
is  from  five  to  ten  drops.  It  has  been  suggested  as  an  objection  to 
this  preparation,  that  the  ether  might  evaporate,  and  the  phosphorus 
ignite  in  the  stomach. 

The  Prussian  Pharmacopoeia  has  an  Oleum  Phosphoratum,  which 
consists  of  twelve  grains  oi  .phosphorus  dissolved  in  an  ounce  of 


CALORIC. 


497 


almond  oil.  The  solution  is  of  the  same  strength  as  the  ethereal 
solution,  and  consequently,  may  be  prescribed  in  the  same  doses. 
Both  the  preparations  may  be  given  in  some  mucilaginous  liquid,  to 
which  any  aromatic  water  or  oil  may  be  added. 

It  need  hardly  be  said,  that  the  greatest  caution  should  be  used 
in  the  administration  of  this  powerful  agent;  nor  does  it  appear  to 
possess  any  properties  that  might  not  be  as  well  supplied  by  agents 
that  are  more  manageable. 

45.  CALOR'IC. 

Under  Diaphoretics  the  effect  of  Caloric  of  a lower  temperature 
than  that  of  the  human  body  was  considered.  We  have  here  to 
regard  it  at  a higher  temperature,  and  one  in  which  it  is  excitant. 

a.  HOT  AIR  BATH. 

When  air  is  heated  to  98°  — the  temperature  of  the  body — and 
upwards  as  far  as  130°,  it  acts  as  a powerful  excitant  to  the  organic 
actions ; and  hence  is  adapted  for  congestive  cases,  in  which  the 
blood  has  accumulated  in  the  internal  organs,  and  has  left  the  surface 
of  the  body.  Accordingly,  in  certain  cases  of  congestive  intermittents 
and  remittents,  it  may  be  advisable.  It  has,  likewise,  been  used  in  the 
algid  period  of  cholera.  Dr.  Pereira  affirms,  that  it  is  highly  useful 
in  asphyxia  from  drowning  and  from  some  other  causes;  yet  the  best 
opinion  would  seem  to  be,  that  exposure  of  one  labouring  under  as- 
phyxia to  very  elevated  temperature  can  scarcely  fail  to  be  injurious. 

The  excitant  and  revellent  action  of  the  hot  air  bath  is  likewise 
exhibited  in  cases  of  chronic  rheumatic  and  neuralgic  affections. 
Sometimes,  it  is  rendered  more  excitant  by  being  impregnated  with 
essential  oils,  or  with  sulphurous  acid  gas  or  chlorine ; and  it  has 
proved  beneficial  in  certain  chronic  cutaneous  diseases, 

h.  HOT  VAPOUR  BATH. 

The  vapour  bath,  at  a temperature  of  from  120°  to  140°,  is  an 
excitant  to  all  the  organic  actions,  and  is,  therefore,  adapted  to  the 
same  class  of  cases  as  the  hot  air  bath.  In  addition,  however,  it  re- 
laxes the  skin,  and  is  accompanied  by  profuse  sweating.  Hence,  it 
can  be  employed  with  great  advantage  in  long  protracted  diseases  of 
the  rheumatic  or  neuralgic  kind  ; and  in  debilitated  individuals,  in 
whom  it  is  desirable  to  produce  an  excitation  of  the  cutaneous  sys- 
tem, and  thus  detract  from  mischief  that  may  be  existing  internally. 
It  has  been  successfully  employed  in  rheumatic  and  other  affections, 
which  have  completely  crippled  the  sufferers ; and  by  some  cures  of 
this  nature  that  have  been  effected,  it  has  attracted  attention  to  a 
class  of  ignorant  empirics,  who  employ  it  largely,  combined  or  not 
with  other  excitants.  The  regular  practitioner  has  too  much  ne- 
glected this  potent  agent : no  hospital,  indeed,  should  be  without  an 
apparatus  for  the  purpose.  It  is  certainly  more  efficacious  in  some 
affections  than  the  ordinary  aqueous  baths  are  in  any. 

42* 


498 


SPECIAL  EXCITANTS. 


In  Russia,  the  vapour  bath  is  used  as  a luxury,  and  the  author  has 
cdsewhere  referred  to  the  impunity  with  which  the  bather  leaves  a 
temperature  of  137°  to  pass  into  one  not  above  32°.  This  form  of 
bath  is  becoming  introduced  into  other  countries. 

The  vapour  of  hot  water  is  sometimes  applied  topically,  in  af- 
fections of  the  joints,  for  example  ; and  a douche  or  stream  of  hot  va- 
pour is  sometimes  made  to  impinge  on  a part  affected  with  neuralgia 
with  advantage.  Occasionally,  too,  aromatics  are  volatilised,  and 
mixed  with  the  watery  vapour,  as  well  as  sulphurous  acid  gas  and 
chlorine. 

C.  HOT  WATER  BATH. 

The  hot  water  bath  is  one  in  which  the  temperature  of  the  water  ex- 
ceeds 98°  of  Fahrenheit’s  scale.  It  differs  essentially  in  its  effects 
upon  the  system  from  the  warm  bath  : whilst  the  latter  is  soothing, 
and  disposing  to  mental  and  corporeal  quietude,  the  former  is  ex- 
citant, stimulating  the  nervous  and  vascular  systems  to  a degree 
which,  in  particular  predispositions  and  habits,  and  during  the  exist- 
ence of  certain  diseases  — those  of  nervous  and  vascular  erethism, 
for  example  — is  positively  injurious.  This  is  readily  understood, 
when  we  reflect  upon  the  effects  occasioned  by  immersing  the  healthy 
body  in  a bath  of  this  kind  : the  bulk  of  the  extremities  is  increased, 
so  that  rings  become  too  small  for  the  fingers  ; the  fluids  expand  ; 
and  hence  the  supervention  of  the  most  manifest  signs  of  polysemia. 
The  pulse  becomes  quick ; the  respiration  accelerated  and  embar- 
rassed ; the  carotid  and  temporal  arteries  beat  violently ; a feeling  of 
anxiety  is  experienced  in  the  praecordial  region;  and  these  phenomena 
are,  at  times,  accompanied  or  followed  by  palpitations,  fainting, 
vertigo,  and  occasionally,  by  apoplexy.  All  these  effects  are  more 
marked,  the  hotter  the  bath;  the  longer  the  person  remains  in  it,  and 
the  greater  the  degree  of  plethora.  It  ought,  consequently,  to  be 
employed  with  caution,  where  there  is  a predisposition  to  apoplexy, 
or  any  other  form  of  hemorrhage,  or  to  violent  internal  inflammation. 

The  hot  water  bath  is  not  much  used  therapeutically,  but  is  adapt- 
ed for  the  same  cases  as  the  hot  vapour  bath,  and  particularly  for 
rheumatic  and  neuralgic  affections.  Astonishing  cures  have  been 
effected  in  such  cases  by  immersion  in  the  hot  springs  of  Virginia, 
the  highest  temperature  of  which  is  107°;  and  which  have  the  ad- 
vantage, possessed  by  no  artificial  bath,  that  the  water  is  always  main- 
tained at  the  same  heat,  no  matter  howprolonged  the  immersion  maybe. 

Caloric  is  employed  topically  as  an  excitant.  Hot  bricks,  bottles 
filled  with  hot  water,  &c.,  are  applied  to  the  feet  to  excite  irritation 
in  diseases  that  are  attended  by  cold  extremities,  as  in  the  cold  stage 
of  intermittent,  &c.  The  same  agents,  or  hot  flannels,  or  hot  salt,  or 
hot  sand,  are  used  in  cases  of  abdominal  pain,  in  which  their  action 
is  also  revellent. 

46.  ELEUTRMy'lTY. 

Electricity,  in  all  its  forms,  is  excitant,  and  has  been  employed 


ELECTRICITY. 


499 


extensively,  at  various  times,  in  the  treatment  of  disease.  The  ap- 
paratus necessary  for  the  medical  electrician  is  sufficiently  simple. 
It  consists  of  a cylindrical  or  plate  machine — one  or  two  Leyden  jars — 
an  electrometer  to  regulate  the  strength  of  the  shock  from  the  jars  — 
a discharging  rod,  that  allows  a ball  to  be  unscrewed,  leaving  a point 
in  its  place  ; and  an  insulated  stool.  These  are  always  attainable  ; 
they  form  part,  indeed,  of  the  ordinary  electrical  apparatus  for  ex- 
periments, as  well  as  for  the  therapeutical  application  of  electricity. 

The  subjoined  figure  from  Pereira  exhibits  the  electrical  apparatus 
for  medical  purposes,  in  ordinary  use. 

Fig.  76. 


Electrical  Apparatus  for  Medical  purposes. 


Friction  Electricity. 

a.  Cylindrical  Machine. 

b.  Medical  Electrometer. 

c.  Insulating  Stool. 
d d.  Leyden  Jars. 

e e e.  Insulated  Directors. 

/.  Discharging  Kod. 

g.  Glass  Tube  traversed  by  a wire,  which  ter- 
minates at  one  end  by  a loop,  at  the  other  by 
a brass  ball. 


Voltaic  Electricity, 
h.  Cruickshank’s  Wooden  Trough. 
i i.  Directors,  each  consisting  of  a glass  tube  tra- 
versed by  a wire,  one  extremity  of  which  is 
connected  with  one  end  of  the  trough  — while 
the  other  extremity  is  surmounted  by  sponge 
or  flannel  moistened  with  salt  and  water. 

Magnetic  E ectricity. 

k.  Clarke’s  Magneto  electric  Machine. 

l.  Directors. 


When  it  is  desirable  to  subject  the  patient  to  the  influence  of  the 
electric  bath,  he  is  placed  on  the  insulated  stool,  and  lays  hold  of  a 
chain  communicating  with  the  prime  conductor  of  the  electrical  ma- 
chine, so  that  when  the  machine  is  in  action,  he  forms  really  a part 
of  the  conductor.  Positive  electricity  is,  consequently,  discharged 
by  him  at  all  points,  and  if  an  uninsulated  metallic  knob  be  brought 
near  him,  a spark  is  communicated  to  it  in  the  same  manner  as  if  it 
approached  the  prime  conductor.  The  effect  of  this  electric  condi- 
tion is  excitant ; but  no  very  marked  influence  is  exerted  on  the 
functions,  in  the  generality  of  cases.  Dr.  A.  T.  Thomson,  however, 
states,  that  a clergyman  — in  whom  he  never  could  produce  perspira- 
tion by  any  of  the  ordinary  diaphoretics,  and  who  never  perspired 
by  exercise,  or  the  heat  of  summer  — when  insulated  and  electrified 
perspired  freely. 

If  when  the  patient  is  placed  upon  the  insulated  stool,  and  the 
machine  is  in  action,  an  uninsulated  metallic  point  be  held  near  any 
part  of  his  person,  the  electric  aura  may  be  drawn  from  him.  Or  if 


500 


SPECIAL  EXCITANTS. 


an  insulated  metallic  director,  or  wire  connected  with  the  prime 
conductor,  be  held  near  the  part  to  be  electrified,  the  electric  aura 
or  a current  of  electrified  air  will  pass  from  the  point  to  him.  A 
sensation,  resembling  that  produced  by  a stream  of  air,  is  felt  on  the 
part,  and  it  acts  as  a gentle  excitant  to  delicate  structures,  as  the  eye 
or  ear,  and  to  excoriated  or  ulcerated  surfaces. 

If  we  are  desirous  of  employing  a greater  amount  of  excitant  in- 
fluence, recourse  is  had  to  the  electric  spark;  which  is  applied  either 
by  placing  the  individual  on  an  insulated  stool,  and  bringing  the 
knuckle,  or  the  ball  of  an  uninsulated  director  near  him  ; or  by  pre- 
senting to  the  part  to  be  electrified  the  knob  of  an  insulated  direc- 
tor connected  with  the  prime  conductor.  In  the  former  case,  the 
spark  is  drawn  from  the  patient  ; in  the  latter  it  is  conveyed  to  him  ; 
yet  the  therapeutical  eflfect  is  alike  in  both  cases.  The  sparks  will 
be  more  or  less  powerful  according  to  the  distance  at  which  the  knob 
is  held  ; and,  in  all  cases,  if  they  be  of  any  size,  a pungent  sensa- 
tion is  experienced ; and  if  a succession  of  sparks  be  drawn,  the 
part  may  be  made  red,  and  a small  spot  or  wheal  be  induced,  which 
soon,  however,  disappears.  Where  it  is  desired  to  electrify  deep- 
seated  parts  — as  the  uterus  through  the  vagina,  or  the  meatus  audi- 
torius  internus  — the  conducting  wire,  terminating  in  a small  knob, 
is  made  to  pass  through  a glass  tube. 

The  sparks  may  be  greatly  diminished  in  size  if  the  part  be  co- 
vered with  flannel  ; and  this  is  a favourite  mode  of  applying  elec- 
tricity with  some.  The  patient  being  on  the  insulated  stool,  the 
knob  of  an  uninsulated  director  may  be  placed  in  close  contact  with 
the  flannel,  moving  it  steadily  and  rapidly,  so  as  to  draw  a multi- 
tude of  small  sparks.  This  plan  has  been  termed,  by  some,  electric 
friction. 

But  the  most  violent  effect  is  produced  by  the  shock.  In  this  case, 
the  part  of  the  body,  to  be  electrified,  is  made  to  form  a portion  of 
the  circuit,  through  w’hich  the  electric  discharge  has  to  pass  from 
one  side  of  a Leyden  jar  to  the  other.  The  jar  is  charged  from  the 
prime  conductor  ; and  around  its  exterior,  and  communicating  with 
the  tinfoil  surrounding  it,  a chain  is  placed,  which  is  again  con- 
nected with  the  ball  of  an  insulated  director.  This  ball,  thus  com- 
municating with  the  exterior  of  the  jar,  is  brought  in  contact  with 
one  side  of  the  part  to  be  electrified,  whilst  the  knob  of  the  jar, 
Avhich  communicates  with  the  inner  coating,  is  brought  in  contact 
with  the  opposite  side.  The  discharge  then  takes  place  instanta- 
neously with  a shock;  and  by  means  of  the  ‘‘medical  electro- 
meter”— as  it  is  termed  — the  strength  of  the  charge  can  be  gra- 
duated. The  effects,  produced  by  the  shock,  vary  greatly  accord- 
ing to  the  intensity  of  the  charge.  They  may  merely  consist  in  a 
slightly  disagreeable  sensation  ; or  may  be  extremely  painful  ; and, 
w’hen  very  intense,  may  destroy  life.  This  method  of  electrifying, 
consequently,  requires  more  circumspection  than  the  others ; and 
may  not  be  at  all  adapted  for  those  who  are  very  impressible. 

The  electric  current.,  as  it  is  termed,  consists  in  connecting  a part 


GALVANISM. 


501 


of  the  patient’s  body  with  the  prime  conductor  in  action,  so  that  the 
electricity  shall  pass  through  the  body  to  the  ground.  This  is,  how- 
ever, so  feeble  an  agency  as  to  be  scarcely  worthy  of  the  attention 
of  the  therapeutist. 

Electricity  is  employed  as  an  excitant  in  a variety  of  affections. 
In  paralysis,  it  has  been  most  extensively  used,  and  especially  in 
cases  of  the  partial  form.  Where  the  mischief  is  encephalic,  it 
need  scarcely  be  said,  that  much  good  cannot  be  expected  from  it ; 
yet  favourable  testimony  has  been  adduced  even  in  these  cases,  by 
Dr.  Golding  Bird.  In  nervous  deafness,  sparks  have  been  given  to, 
or  taken  from,  the  mastoid  process,  and  around  the  meatus  audito- 
rius  externus,  and  the  bottom  of  the  meatus.  The  same  agency,  as 
well  as  the  electric  aura,  has  been  employed  in  amaurosis,  but  it  too 
often  fails.  It  has  also  been  largely  used  in  chronic  rheumatism,  and 
in  the  stiffness  and  rigidity  that  follow  sprains  or  bruises.  Of  its  use 
as  an  emmenagogue,  mention  is  made  elsewhere,  (p.  415.)  It  has 
likewise  been  prescribed  in  the  form  of  electric  friction  or  of  slight 
shocks^  to  promote  the  biliary  secretion,  and  to  modify  the  function 
of  nutrition,  so  as  to  discuss  indolent  tumours ; and  recent  obser- 
vers have  afforded  testimony  as  to  its  advantages  in  chorea  and 
other  neuroses,  in  the  form  of  electrification  or  of  slight  shocks  along 
the  spine.  At  one  time,  it  was  much  more  largely  used  than  at  pre- 
sent ; and,  although  a stimulus  has  been  afforded  to  its  re-employ- 
ment by  the  testimony  of  recent  observers,  as  of  Messrs.  Addison 
and  G.  Bird,  the  cases  in  which  it  can  be  productive  of  much 
benefit  are  probably  very  limited. 

47.  GAL'VANISM. 

The  therapeutical  effects  of  galvanic  or  voltaic  electricity  are  like 
those  of  ordinary  electricity  ; and  it  has  been  used  in  the  same 
cases  — in  paralysis,  general  and  local ; in  amaurosis  ; deafness  and 
dumbness  of  recent  duration,  rheumatism,  &c. 

The  apparatus,  usually  employed,  (p.  499)  consists  of — 1.  Two 
Cruickshank’s  batteries,  each  containing  fifty  pairs  of  copper  and  zinc 
plates,  three  inches  square  ; 2.  of  copper-wire  communicating  with 
each  end  of  the  battery  ; and  3.  of  two  insulated  directors,  consisting 
of  a glass  tube,  through  which  the  wire  from  each  end  of  the  battery 
passes  — the  free  extremity,  which  has  to  be  brought  in  contact  with 
the  part  to  be  galvanised,  being  covered  with  sponge  or  flannel, 
moistened  with  a solution  of  common  salt.  When  the  battery  is  to 
be  put  in  action,  it  may  be  charged  with  a solution  of  common  salt, 
or  with  a weak  acid  liquor,  consisting  of  not  more  than  1 -500th  part 
of  muriatic  acid  ; and  where  the  skin  is  very  sensible,  water  alone 
may  be  used.  (Pereira.)  The  wire  or  electrode  communicating 
with  one  pole  of  the  battery  is  then  applied  to  the  part  to  be  galvanised  ; 
and  the  other  electrode  at  a distance  from  it  so  as  to  include  the 
affected  part  in  the  circuit.  The  circuit  may  be  rapidly  broken  or 
completed,  as  the  operator  considers  proper. 

A different  mode  of  application  has  been  introduced ; to  which 


502 


SPECIAL  EXCITANTS. 


the  name  MansfortPs  Plates  has  been  occasionally  given,  after  its 
proposer.  It  consists  essentially  in  removing  the  cuticle  from  two 
parts  of  the  cutaneous  surface  ; applying  a plate  of  silver  to  one  ex- 
coriated surface,  and  a plate  of  zinc  to  the  other,  and  connecting  thetwo 
by  means  of  a copper  wire.  The  exact  steps  of  the  process  the  author 
has  given  elsewhere.  {JYew  Remedies,  4th  edit.  p.  326:  Philad.  1843.) 

Under  the  idea,  that  the  galvanic  and  nervous  fluids  are  identical. 
Dr.  W.  Philip  employed  galvanism  successfully  in  asthma  ; trans- 
mitting the  influence  from  the  nape  of  the  neck  to  the  pit  of  the  sto- 
mach, with  a power  varying  from  ten  to  twenty-five  pairs  of  plates. 
In  these  cases,  it  probably  acts  as  a revellent,  its  excitant  agency 
making  a new  impression  on  the  nerves,  which  detracts  or  derives 
from  the  erethism  in  the  respiratory  nerves.  In  cases,  too,  which 
are  dependent  upon  paralysis  of  those  nerves,  the  excitant  influence 
of  galvanism  may  be  beneficial.  In  the  same  way,  we  explain  the 
salutary  agency  of  the  plates  in  epilepsy  ; in  angina  pectoris,  and  in 
neuralgic  affections  of  the  chest  especially,  and  in  paraplegia. 

Cases  of  good  effects  from  the  action  of  the  galvanic  battery  in 
amaurosis  have  been  published  by  Dr.  Hays,  of  Philadelphia,  the 
galvanic  current  being  made  to  pass  from  the  mastoid  process  to  the 
superciliary  ridge. 

• Galv^anism  has  likewise  been  suggested  as  a remedy  in  cases  of 
asphyxia,  and  the  suggestion  is  good.  It  has,  however,  very  often 
failed ; and  as  the  cessation  of  the  heart’s  action  is  the  cause  of  death, 
and  galvanism  exerts  little  or  no  influence  on  that  organ,  it  is  probable 
that  it  may  not  render  as  much  service  as  was  at  onetime  anticipated. 

The  battery  forms  part  of  every  perfect  resuscitatingapparatus. 

48.  The  Electro-Magnet'ic  Appara'tus  was  brought  forward  as 
a valuable  excitant  a few  years  ago  ; but  it  did  not  appear  to  have 
any  advantage  over  the  ordinary  mode  of  employing  galvanism  by  the 
battery ; whilst  the  shocks  in  rapid  succession  were  often  extremely 
disagreeable.  It  is  now  rarely  employed,  and,  indeed,  the  same  may 
be  said  of  galvanism  in  general. 

For  some  of  the  other  inventions  of  a galvanic  nature,  proposed  by 
different  individuals  — as  the  anodyne  metallic  or  galvanic  brush  of 
Von  Hildenbrand  ; and  galvanic  snypositories,  &c.,  of  Harrington, 
the  author  may  refer  to  the  work  just  cited.  [JYew  Remedies,  p.  328.) 
They  are  no  longer  used. 

49.  A'CUPUNCTURE. 

The  operation  of  acupuncture,  or  acupunctura'tion,  is  performed  by 
fine,  well-polished,  and  sharp-pointed  needles.  These  are  usually 
from  two  to  four  inches  long;  and  at  the  blunt  extremity  of  the 
needle,  a head  of  lead  or  sealing-wax  is  attached  to  prevent  it  from 
being  forced  entirely  into  the  body.  To  introduce  the  needle  the 
skin  is  stretched,  and  it  is  inserted  by  a movement  of  rotation,  aided 
by  gentle  pressure.  The  number  of  needles  to  be  used,  and  the 
length  of  time  they  should  remain,  must  be  determined  by  the  nature 
of  the  case,  and  the  judgment  of  the  practitioner. 


ACUPUNCTURE. 


503 


Acupuncturation  is  an  old  Japanese  remedy,  which  was  used  in 
Europe  a long  time  ago,  and  has  been  revived  of  late  years  in  the 
same  kind  of  cases,  in  which  electricity  and  galvanism  are  employed ; 
— for  example,  in  rheumatic,  spasmodic,  and  convulsive  affections, 
amaurosis,  paralysis.  Sac. ; and  it  has  even  been  proposed  to  pass 
them  into  the  heart  in  cases  of  asphyxia  ! In  rheumatic  affections  its 
success  has  been  marked.  Dr.  Elliolson  having  cured  thirty  out  of 
forty-two  cases  by  it.  It  has  also  been  used  in  gout. 

When  acupuncture  is  conjoined  with  electricity  or  galvanism,  it 
constitutes  Elec'tropuncture  or  Gal'vanopuncture.  The  opera- 
tion consists  in  employing  acupuncturation  in  the  usual  way,  either 
with  a single  needle,  or  with  two  or  more,  and  making  a communi- 
cation between  them  and  the  prime  conductor  of  an  electrical  ma- 
chine ; or  they  may  be  made  to  form  part  of  the  circuit  in  the  dis- 
charge of  a Leyden  jar.  In  this  way,  the  electrical  influence  may 
be  graduated  from  the  simple  aura  to  a full  shock.  Both  it  and 
galvanopuncture  have  been  used  in  the  same  cases,  as  acupunctura- 
tion, and  especially  in  rheumatic  and  neuralgic  affections. 

Galvanopuncture  has  been  employed  in  cases  of  asphyxia  : it 
has  even  been  suggested  to  pass  the  needles,  on  each  side,  between 
the  eighth  and  ninth  ribs,  until  they  reach  the  fibres  of  the  diaphragm, 
and  then  to  establish  a galvanic  current  between  them,  by  means 
of  a pile  of  25  or  30  pairs  of  plates,  an  inch  in  diameter.  Some- 
times the  circle  was  interrupted,  at  others  continuous.  This  plan 
was  tried  by  Leroy  d’Etiolles  on  animals  asphyxied  by  submersion  ; 
and,  when  they  had  not  been  under  water  more  than  five  minutes, 
they  were  often  restored.  As  an  aid,  therefore,  — as  the  author  has 
elsewhere  said,  — to  pulmonary  insufflation,  galvanism,  combined 
or  not  with  acupuncturation,  might  be  employed  in  asphyxia  ; but 
it  cannot  often,  perhaps,  be  available  ; certainly,  no  time  should  be 
lost  in  adopting  the  other  energetic  and  indispensable  measures  that 
are  demanded.  It  has  been  recommended  that  as  only  a very  small 
apparatus  is  necessary,  batteries,  consisting  of  a few  plates,  might 
be  kept  wherever  there  are  station-houses  for  the  reception  of  per- 
sons in  a state  of  asphyxia.  This  suggestion  also  is  good,  and 
they  might  form  a part  of  the  cabinet  apparatus  of  the  private  prac- 
titioner ; but  whilst  an  assistant  is  preparing  the  apparatus  for  ac- 
tion, the  practitioner  should  be  assiduously  engaged  in  employing 
other  means  of  resuscitation. 

50.  EXUI'TANT  GAS'ES. 

Of  the  gases,  whose  effects,  when  inhaled,  are  excitant,  but  two 
have  been  used,  — Oxygen  and  Protoxide  of  Azote  ; but  neither 
is  much  employed  a'’  a therapeutical  agent  at  the  present  day. 

a.  OX'YGEN  GAS. 

This  gas,  which  is  so  essential  to  respiration  as  to  have  been 
termed  vital  air^  has  been  subjected  to  numerous  experiments,  the 
general  results  of  which  are, — ^that  it  acts  upon  the  human  organism  in 


504 


SPECIAL  EXCITANTS. 


a positively  deleterious  manner  ; and  that  although  an  animal  may  live 
in  a limited  portion  of  it  for  a considerable  time  longer  than  in  the 
same  quantity  of  atmospheric  air,  its  respiration  becomes  hurried  and 
laborious  before  the  whole  is  consumed,  and  it  dies,  although  a 
fresh  animal  of  the  same  kind  is  capable  of  sustaining  life  for  some 
time  in  the  residuary  air. 

Oxygen  gas,  for  therapeutical  administration,  may  be  made  from 
black  oxide  of  manganese,  exposed  to  a full  red  heat  in  an  iron  retort, 
the  gas  being  transmitted  through  water.’ 

It  has  been  advised  as  an  excitant  inhalation  in  chronic  debility 
of  all  kinds  ; and  especially  in  anaemia,  chlorosis,  paralysis,  &c. 
It  should  be  diluted  with  from  ten  to  twenty  times  its  bulk  of  at- 
mospheric air,  increasing  the  proportion  of  oxygen  according  to  the 
effects  induced.  From  one  to  two  quarts  of  oxygen  may  be  breathed 
in  the  course  of  the  day.  It  is  said  to  augment  the  force  and  velo- 
city of  the  pulse. 


This  gas,  called  also  JYitroiis  Oxide  Gas,  Protox'ide  of  JVi'trogen, 
Par'adise,  hitox'icating  and  Laughing  Gas,  in  now  rarely  used  ex- 
cept for  purposes  of  exhibition.  It  may  be  obtained  for  medicinal 
objects  by  decomposing  nitrate  of  ammonia  by  means  of  heat,  and 
transmitting  the  gas  through  water.  The  hydrogen  of  the  ammonia 
attracts  part  of  the  oxygen  of  the  nitric  acid,  and  forms  water  ; and 
the  remaining  oxygen,  combining  with  the  azote  both  of  the  acid 
and  the  ammonia,  forms  the  protoxide. 

The  effects  of  this  gas,  when  inhaled,  are  usually  singular  and 
delightful.  It  was  breathed  by  Sir  Humphry  Davy,  Mr.  Southey, 
Mr.  Wedgwood  and  others,  whose  sensations  have  been  detailed  by 
Sir  Humphry.  The  effects  are  most  exhilarating  and  excitant,  and 
they  are  not  followed,  in  the  generality  of  cases,  by  depression.  It 
is  apt,  however,  to  disagree  with  those  whose  nervous  systems  are 
very  impressible,  and  might  be  dangerous  to  such  as  are  predisposed 
to  encephalic  or  cardiac  disease.  On  some  few  its  effects  are  by 
no  means  agreeable,  or  transient. 

Possessed  of  these  powers,  it  was  not  surprising,  that  the  inhala- 
tion of  this  gas  should  be  regarded  with  interest  as  a therapeutical 
agent.  It  has  not,  however,  answered  the  expectations  of  experi- 
menters. It  has  been  inhaled  in  paralysis,  and  apparently  with 
advantage  ; but  it  is  difficult  to  say  how  much  of  the  benefit  was 
owing  to  the  inhalation,  and  how  much  to  the  effect  on  the  mind  of 
the  patient.  (See  page  31.)  The  quantity  required  to  produce  its 
effects  is  usually  from  four  to  nine  quarts,  which  may  be  inhaled 
pure  or  mixed  with  an  equal  quantity  of  atmospheric  air.  It  cannot 
be  breathed  undiluted,  it  is  affirmed  by  Dr.  J.  Murray,  for  more  than 
four  minutes  and  a half,  consequently  its  elfects  must  be  watched. 
It  is  hardly  ever  used  at  the  present  day. 


h.  protox'ide  of  a'zote. 


END  OF  VOLUME 


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